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General NPI Number Information
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NPI Number | 1801926324
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Entity Type | Organization
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Legal Business Name | DESERT GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 2625 WIGWAM PKWY STE 112
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City | HENDERSON
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State | NV
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Zip | 89074-7326
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Country | US
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Telephone | 702-255-5900
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Fax | 702-255-5980
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Provider Business Mailing Address
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Address Line | 2625 WIGWAM PKWY STE 112
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City | HENDERSON
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State | NV
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Zip | 89074-7326
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Country | US
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Telephone | 702-255-5900
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Fax | 702-255-5980
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADEDAYO O MOKUOLU
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Credential |
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Telephone | 702-255-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 5306
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License Number State | NV
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