MEDICARE: EILEEN CORDERO MAUBAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	7858	NV

General Provider Information

NPI Number	:	1396745774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN CORDERO MAUBAN M.D.

Provider Business Mailing Address
First Line	:	1800 W. CHARLESTON BLVD. STE. 508
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2688
Fax Number	:	702-671-6595

Provider Business Practice Location Address
First Line	:	525 MARKS STREET
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014
Country	:	US
Telephone Number	:	702-671-1000
Fax Number	:	702-458-0610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	09/19/2018

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