MEDICARE: RENE A 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	207Q00000X	Family Medicine Physician	6517	NV

General Provider Information

NPI Number	:	1659371037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE A 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	:	2031 NORTH BUFFALO DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-383-2650
Fax Number	:	702-256-2213

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	11/01/2018

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