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General NPI Number Information
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NPI Number | 1023964657
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Entity Type | Organization
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Legal Business Name | FORMA INTEGRATED HEALTHCARE
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 2655 S RAINBOW BLVD STE 410
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City | LAS VEGAS
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State | NV
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Zip | 89146-5100
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Country | US
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Telephone | 702-726-9722
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Fax | 702-906-0067
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Provider Business Mailing Address
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Address Line | 2655 S RAINBOW BLVD STE 410
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City | LAS VEGAS
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State | NV
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Zip | 89146-5100
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Country | US
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Telephone | 702-726-9722
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Fax | 702-906-0067
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Authorized Official
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Title or Position | CEO
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Name | ANN UGANIZA
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Credential |
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Telephone | 702-531-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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