Individual
DR. AGATHA MATSOS FORMOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2650 N TENAYA WAY # 308, LAS VEGAS, NV 89128-1102
(702) 870-2099
(702) 869-5347
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24172
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2020
Last updated
11/16/2023
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