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General NPI Number Information
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NPI Number | 1902298243
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Entity Type | Organization
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Legal Business Name | AUMBRIA HEALTH AND AESTHETICS LLC
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1301 BERTHA HOWE AVE STE# 2
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-345-3312
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Fax | 702-345-3374
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Provider Business Mailing Address
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Address Line | 1301 BERTHA HOWE AVE STE# 2
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-345-3312
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Fax | 702-345-3374
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. GLADYS AMPONG KODJOE
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Credential | M.D.
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Telephone | 702-241-8721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13300
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License Number State | NV
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