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General NPI Number Information
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NPI Number | 1881008183
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Entity Type | Organization
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Legal Business Name | WESTTEAM CORP
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 3430 E FLAMINGO RD SUITE 302
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City | LAS VEGAS
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State | NV
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Zip | 89121-5003
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Country | US
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Telephone | 702-628-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 E FLAMINGO RD SUITE 302
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City | LAS VEGAS
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State | NV
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Zip | 89121-5003
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Country | US
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Telephone | 702-628-4649
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOELVIS GAMBOA
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Credential | CEO
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Telephone | 702-628-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | V101990
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License Number State | NV
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