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General NPI Number Information
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NPI Number | 1952589541
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Entity Type | Organization
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Legal Business Name | NICOLE J. MOSS, M.D., LTD.
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 2931 N TENAYA WAY SUITE 204
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City | LAS VEGAS
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State | NV
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Zip | 89128-0456
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Country | US
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Telephone | 702-233-2123
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Fax | 702-233-0398
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Provider Business Mailing Address
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Address Line | 2931 N TENAYA WAY SUITE 204
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City | LAS VEGAS
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State | NV
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Zip | 89128-0456
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Country | US
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Telephone | 702-233-2123
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Fax | 702-233-0398
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Authorized Official
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Title or Position | LLC MANAGING MEMBER
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Name | DR. NICOLE JULIANA MOSS
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Credential | M.D.
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Telephone | 702-242-2782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 9708
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License Number State | NV
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