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General NPI Number Information
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NPI Number | 1205268695
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Entity Type | Organization
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Legal Business Name | EXDOUS FAMILY & GUIDANCE COALITION LLC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 1415 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89104-3311
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Country | US
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Telephone | 702-569-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89104-3311
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Country | US
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Telephone | 702-569-4455
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | MYRNA PILI
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Credential |
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Telephone | 702-569-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | NV20131436018
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License Number State | NV
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