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General NPI Number Information
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NPI Number | 1942357017
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Entity Type | Organization
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Legal Business Name | PETAR JAMBORCIC, MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 8285 W ARBY AVE STE 390
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City | LAS VEGAS
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State | NV
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Zip | 89113-2237
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Country | US
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Telephone | 702-614-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 8285 W ARBY AVE STE 390
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City | LAS VEGAS
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State | NV
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Zip | 89113-2237
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Country | US
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Telephone | 702-614-1250
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYN M RODRIGUEZ
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Credential | MD
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Telephone | 323-213-5884
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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 | 14006
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License Number State | NV
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