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Organization
S PANNU INC
Active
Organization
S PANNU INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI A LABRECQUE (ACCTS. MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
1800 SPRING RIDGE DR, SUSANVILLE, CA 96130-6100
(530) 252-2000
Mailing address
10624 S EASTERN AVE, SUITE 263, HENDERSON, NV 89052-2982
(702) 597-1597
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
8682
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018039
—
NV
01
—
A56442
MEDICAL LIC
CA
Enumeration date
03/08/2007
Last updated
06/01/2009
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