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General NPI Number Information
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NPI Number | 1407121320
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 1800 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2329
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Country | US
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Telephone | 702-822-5433
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Fax | 702-944-0453
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Provider Business Mailing Address
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Address Line | 1 BREAKTHROUGH WAY
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City | LAS VEGAS
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State | NV
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Zip | 89135-3011
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Country | US
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Telephone | 702-822-5433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MICKEY GOLDMAN
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Credential | FACHE
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Telephone | 702-821-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | NV
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