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General NPI Number Information
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NPI Number | 1982876744
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Entity Type | Organization
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Legal Business Name | SOUTH HILLS GASTROENTEROLOGY LLP
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 2625 WIGWAM PKWY SUITE 112
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City | HENDERSON
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State | NV
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Zip | 89074-7325
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Country | US
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Telephone | 702-858-9328
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Fax | 702-202-3455
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Provider Business Mailing Address
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Address Line | 7365 PRAIRIE FALCON RD SUITE 140
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City | LAS VEGAS
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State | NV
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Zip | 89128-0807
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Country | US
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Telephone | 702-202-3431
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Fax | 702-202-3455
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Authorized Official
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Title or Position | MEMBER
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Name | CARMELO HERRERO
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Credential | MD
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Telephone | 702-858-9328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 8613
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License Number State | NV
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