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General NPI Number Information
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NPI Number | 1023420759
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Entity Type | Organization
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Legal Business Name | WOMEN'S CANCER CENTER DIVISION OF COLORECTAL SURGERY
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 3131 LA CANADA ST STE 241
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City | LAS VEGAS
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State | NV
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Zip | 89169-2588
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Country | US
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Telephone | 702-326-0585
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Fax | 702-835-0041
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Provider Business Mailing Address
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Address Line | 3131 LA CANADA ST STE 241
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City | LAS VEGAS
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State | NV
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Zip | 89169-2588
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Country | US
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Telephone | 702-326-0585
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Fax | 702-835-0041
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MELANIE LUNDY
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Credential |
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Telephone | 702-693-6870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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