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Organization
NATIONAL RETAIL LLC
Active
Organization
NATIONAL RETAIL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADIN BOLDUR MD (MEDICAL DIRECTOR)
(702) 853-5055
Entity
Organization
Contact information
Practice address
4260 CAMERON ST STE A, LAS VEGAS, NV 89103-3718
(702) 853-5055
Mailing address
4260 CAMERON ST STE A, LAS VEGAS, NV 89103-3718
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NV20131357533
SECRETARY OF STATE
NV
Enumeration date
08/15/2022
Last updated
08/16/2022
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