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General NPI Number Information
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NPI Number | 1427697952
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Entity Type | Individual
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Provider Name | FABIOLA SUTY
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Gender | Female
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3270 N BUFFALO DR
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City | LAS VEGAS
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State | NV
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Zip | 89129-7402
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Country | US
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Telephone | 702-676-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 963 CARNIVAL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89123-0916
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2213
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License Number State | NV
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