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General NPI Number Information
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NPI Number | 1548085491
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Entity Type | Organization
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Legal Business Name | 702 FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 11/16/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 3468 E SAHARA AVE STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89104-4827
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Country | US
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Telephone | 702-389-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 3468 E SAHARA AVE STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89104-4827
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Country | US
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Telephone | 702-389-5700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IREDILA TIMAGOS BYNUM
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Credential |
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Telephone | 702-389-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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