Healthcare Provider Details

I. General information

NPI: 1649350174
Provider Name (Legal Business Name): CATHY SUMIKO ENDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 6TH STREET
LOVELOCK NV
89419-0661
US

IV. Provider business mailing address

PO BOX 661
LOVELOCK NV
89419-0661
US

V. Phone/Fax

Practice location:
  • Phone: 775-273-2621
  • Fax: 775-273-5183
Mailing address:
  • Phone: 775-273-2621
  • Fax: 775-273-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7927
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: