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NPI Code Detail

MEDICARE: ARDHA MOBILE MD, LLC

MEDICARE: ARDHA MOBILE MD, LLC
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
1363LF0000XFamily Nurse Practitioner700891NV

General Provider Information

NPI Number : 1578943619
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARDHA MOBILE MD, LLC
Provider Business Mailing Address
First Line : 5418 CULBERTSON ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-8637
Country : US
Telephone Number : 702-324-9373
Fax Number :
Provider Business Practice Location Address
First Line : 2619 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2121
Country : US
Telephone Number : 702-324-9373
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ANGELITA MARTINEZ
Credential :
Telephone Number : 702-324-9373
Provider Enumeration Date : 06/03/2015
Last Update Date : 06/03/2015

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