Healthcare Provider Details

I. General information

NPI: 1417037698
Provider Name (Legal Business Name): RICHARD E OBRINGER PAC PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11413 PERUGINO DR
LAS VEGAS NV
89138-1533
US

IV. Provider business mailing address

11413 PERUGINO DR
LAS VEGAS NV
89138-1533
US

V. Phone/Fax

Practice location:
  • Phone: 702-499-7296
  • Fax:
Mailing address:
  • Phone: 702-499-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RICHARD O'BRINGER
Title or Position: PRESIDENT
Credential:
Phone: 702-499-7296