Organization
CANYON GATE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKI MOSKOW (PRESIDENT)
(954) 656-8855
Entity
Organization
Contact information
Practice address
10155 W TWAIN AVE, SUITE # 110, LAS VEGAS, NV 89147-6722
(702) 243-2689
(702) 243-2632
Mailing address
2929 N UNIVERSITY DR, SUITE # 110, CORAL SPRINGS, FL 33065-5081
(954) 656-8855
(954) 656-8856
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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