Healthcare Provider Details

I. General information

NPI: 1962057414
Provider Name (Legal Business Name): ANTHONY BRANDO OPIMO AGACNP-BC, RN, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 W. SAHARA AVE.
LAS VEGAS NV
89117
US

IV. Provider business mailing address

1800 W. CHARLESTON BLVD.
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-3633
  • Fax: 702-562-2810
Mailing address:
  • Phone: 702-383-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number822977
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: