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General NPI Number Information
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NPI Number | 1487665667
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Entity Type | Organization
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Legal Business Name | FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK LTD
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 2020 SILVER CREEK RD BLDG A #103
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 928-758-0135
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Fax | 928-758-0175
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Provider Business Mailing Address
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Address Line | 2460 W HORIZON RIDGE PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-2736
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Country | US
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Telephone | 702-822-2000
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Fax | 702-938-2237
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | DR. RUSSELL GOLLARD
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Credential | MD
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Telephone | 702-822-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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