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General NPI Number Information
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NPI Number | 1891945796
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Entity Type | Organization
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Legal Business Name | SAMPANG MEDICAL CARE PLLC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 56 DAISY SPRINGS CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-4464
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Country | US
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Telephone | 702-242-1604
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Fax |
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Provider Business Mailing Address
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Address Line | 56 DAISY SPRINGS CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-4464
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Country | US
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Telephone | 702-242-1604
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIRGINIA SAMPANG
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Credential | MD
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Telephone | 702-553-6932
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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 | 12319
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License Number State | NV
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