MEDICARE: EILEEN CORDERO MAUBAN MD LTD

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

General Provider Information

NPI Number	:	1942201116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EILEEN CORDERO MAUBAN MD LTD

Provider Business Mailing Address
First Line	:	2225 E FLAMINGO RD
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	702-731-1747
Fax Number	:	702-731-1661

Provider Business Practice Location Address
First Line	:	2225 E FLAMINGO RD
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	702-731-1747
Fax Number	:	702-731-1661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EILEEN CORDERO MAUBAN
Credential	:	MD
Telephone Number	:	703-731-1747

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/13/2009

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