Organization
CARSON TAHOE PHYSICIAN CLINICS - MINDEN #3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA ROMO (CREDENTIALING COORDINATOR)
(775) 283-3096
Entity
Organization
Contact information
Practice address
925 IRONWOOD DR, SUITE 2105, MINDEN, NV 89423-5178
(775) 445-7745
(775) 782-0073
Mailing address
2874 N CARSON ST, SUITE 200, CARSON CITY, NV 89706-0251
(775) 283-3096
(775) 283-3091
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12752
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568596229
NPI
—
Enumeration date
12/17/2010
Last updated
12/17/2010
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