=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659492379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MESQUITE WOMENS CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 11/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 BERTHA HOWE AVE #2
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89027-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-345-2122
-----------------------------------------------------
Fax | 702-345-3063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 BERTHA HOWE AVE #2
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89027-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-345-2122
-----------------------------------------------------
Fax | 702-345-3063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. EDWARD NELSON OFORI
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 702-345-2122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 1175
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------