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General NPI Number Information
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NPI Number | 1558817213
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Entity Type | Organization
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Legal Business Name | ADVANCED OTOLARYNGOLOGY ASSOCIATES
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 10735 DOUBLE R BLVD
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City | RENO
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State | NV
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Zip | 89521-8977
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Country | US
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Telephone | 775-852-3624
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Fax | 775-852-3672
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Provider Business Mailing Address
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Address Line | 10735 DOUBLE R BLVD
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City | RENO
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State | NV
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Zip | 89521-8977
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Country | US
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Telephone | 775-852-3624
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Fax | 775-852-3672
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | THERESA BIRCHFIELD
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Credential |
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Telephone | 775-813-0186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | NV
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