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General NPI Number Information
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NPI Number | 1508870445
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Entity Type | Organization
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Legal Business Name | FAMILY TREE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 3510 E TROPICANA AVE STE # K
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City | LAS VEGAS
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State | NV
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Zip | 89121-7341
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Country | US
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Telephone | 702-947-1000
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Fax | 702-947-1001
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Provider Business Mailing Address
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Address Line | PO BOX 231930
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City | LAS VEGAS
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State | NV
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Zip | 89105-1930
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Country | US
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Telephone | 702-947-1000
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Fax | 702-947-1001
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Authorized Official
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Title or Position | OWNER
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Name | TONY GUMINA
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Credential | MD
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Telephone | 702-947-1000
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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 | 9897
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License Number State | NV
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