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General NPI Number Information
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NPI Number | 1235527912
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Entity Type | Individual
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Provider Name | MARIA LOGOTAEAO DUBOSE P.A
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 2380 W HORIZON RIDGE PKWY SUITE 110
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City | HENDERSON
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State | NV
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Zip | 89052-5078
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Country | US
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Telephone | 702-823-4255
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Fax |
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Provider Business Mailing Address
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Address Line | 2380 W HORIZON RIDGE PKWY SUITE 110
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City | HENDERSON
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State | NV
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Zip | 89052-5078
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Country | US
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Telephone | 702-823-4255
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1585
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License Number State | NV
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