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Organization
CANYON GATE MEDICAL GROUP
Active
Organization
CANYON GATE MEDICAL GROUP
Active
Other names
canyon gate medical group
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA COLON (CREDENTIALING COORDINATOR)
(954) 656-8855
Entity
Organization
Contact information
Practice address
330 S LOLA LN, SUITE# 200, PAHRUMP, NV 89048-0884
(954) 656-8855
Mailing address
2929 N UNIVERSITY DR, SUITE# 110, CORAL SPRINGS, FL 33065-5081
(775) 751-0695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
936
NV
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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