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General NPI Number Information
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NPI Number | 1093230138
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEVADA MEDICAL & PEDIATRICS ASSOCIATES LLC
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3301 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1835
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Country | US
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Telephone | 702-968-0100
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Fax | 702-968-0104
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Provider Business Mailing Address
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Address Line | 3301 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1835
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Country | US
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Telephone | 702-968-0100
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Fax | 702-968-0104
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CAMILO TABORA JR.
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Credential | MD
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Telephone | 702-968-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 9691
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License Number State | NV
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