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General NPI Number Information
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NPI Number | 1194788398
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Entity Type | Individual
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Provider Name | MR. FRIDAY A. ODONG
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4015 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1612
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Country | US
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Telephone | 702-457-0624
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Fax | 702-310-4653
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Provider Business Mailing Address
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Address Line | 2306 STOCKTON AVE
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City | LAS VEGAS
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State | NV
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Zip | 89104-3823
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Country | US
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Telephone | 702-457-0624
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Fax | 702-310-4653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | H13-00216-6-108724
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License Number State | NV
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