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Organization
PSYCHOPHYLAXIS INSTITUTE LLC
Active
Organization
PSYCHOPHYLAXIS INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUDALODU VASUDEVAN (CEO)
(646) 688-3579
Entity
Organization
Contact information
Practice address
2470 E FLAMINGO RD STE D, LAS VEGAS, NV 89121-5200
(702) 544-3849
Mailing address
164 W INVITAR LN, MOUNTAIN HOUSE, CA 95391-2036
(646) 688-3579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17489
NV
207Q00000X
Family Medicine Physician
4301102270
MI
Other
Enumeration date
11/18/2017
Last updated
11/18/2017
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