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General NPI Number Information
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NPI Number | 1962403121
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Entity Type | Organization
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Legal Business Name | VISTA MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 2909 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1925
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Country | US
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Telephone | 702-798-1233
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Fax | 702-531-1233
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Provider Business Mailing Address
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Address Line | PO BOX 365404
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City | N LAS VEGAS
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State | NV
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Zip | 89036-9404
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Country | US
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Telephone | 702-798-1233
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Fax | 702-531-1233
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOFI E SARFO
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Credential | MD
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Telephone | 702-798-1233
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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 | 11205
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License Number State | NV
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