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General NPI Number Information
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NPI Number | 1164555736
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 2410 FIRE MESA ST STE 180
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City | LAS VEGAS
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State | NV
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Zip | 89128-9016
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Country | US
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Telephone | 702-992-6888
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Fax | 702-992-6880
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Provider Business Mailing Address
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Address Line | PO BOX 98528 DEPT 401
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City | LAS VEGAS
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State | NV
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Zip | 89193-8528
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Country | US
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Telephone | 702-671-2395
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Fax | 702-382-5388
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Authorized Official
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Title or Position | VICE DEAN
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Name | DR. WILLIAM A. ZAMBONI
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Credential | MD
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Telephone | 702-671-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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