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General NPI Number Information
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NPI Number | 1851812978
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Entity Type | Organization
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Legal Business Name | DESERT MEDICAL CLINIC
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1500 E DESERT INN RD STE 4
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City | LAS VEGAS
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State | NV
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Zip | 89169
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Country | US
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Telephone | 702-916-1500
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Fax | 702-916-1458
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Provider Business Mailing Address
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Address Line | 1500 E DESERT INN RD STE 4
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City | LAS VEGAS
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State | NV
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Zip | 89169-2550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ABEL MANUKYAN
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Credential |
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Telephone | 702-540-5049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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