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General NPI Number Information
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NPI Number | 1114782596
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Entity Type | Organization
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Legal Business Name | PACIFIC WEST UROLOGY LLC, A PROFESSIONAL MEDICAL COMPANY
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 4425 S PECOS RD STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89121-5039
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Country | US
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Telephone | 725-225-5575
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Fax | 833-941-2450
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Provider Business Mailing Address
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Address Line | 4425 S PECOS RD STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89121-5039
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Country | US
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Telephone | 725-225-5575
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Fax | 833-941-2450
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JOEL ABBOTT
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Credential | DO
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Telephone | 702-715-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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