Healthcare Provider Details

I. General information

NPI: 1922242007
Provider Name (Legal Business Name): UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD STE 170
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD #215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2359
  • Fax: 702-384-6592
Mailing address:
  • Phone: 702-671-2395
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number9547
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0566
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number9547
License Number StateNV

VIII. Authorized Official

Name: DR. WILLIAM A. ZAMBONI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-671-2278