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General NPI Number Information
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NPI Number | 1235309113
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Entity Type | Organization
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Legal Business Name | DESERT VALLEY FAMILY PRACTICE
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1001 MOUNTAIN ST SUITE 1E
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City | CARSON CITY
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State | NV
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Zip | 89703-3822
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Country | US
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Telephone | 775-882-0777
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Fax | 775-882-3472
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Provider Business Mailing Address
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Address Line | 1001 MOUNTAIN ST SUITE 1E
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City | CARSON CITY
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State | NV
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Zip | 89703-3822
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Country | US
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Telephone | 775-882-0777
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Fax | 775-882-3472
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIE JOHNSON
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Credential |
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Telephone | 775-882-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9437
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License Number State | NV
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