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General NPI Number Information
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NPI Number | 1578943619
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Entity Type | Organization
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Legal Business Name | ARDHA MOBILE MD, LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 2619 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2121
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Country | US
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Telephone | 702-324-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 5418 CULBERTSON ST
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City | LAS VEGAS
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State | NV
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Zip | 89122-8637
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Country | US
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Telephone | 702-324-9373
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELITA MARTINEZ
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Credential |
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Telephone | 702-324-9373
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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 | 700891
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License Number State | NV
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