Organization
CANYON GATE MEDICAL GROUP
Active
Other names
canyon gate medical group
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA COLON (CREDENTIALING COORDINATOR)
(954) 656-8855
Entity
Organization
Contact information
Practice address
330 S LOLA LN, SUITE# 200, PAHRUMP, NV 89048-0884
(954) 656-8855
Mailing address
2929 N UNIVERSITY DR, SUITE# 110, CORAL SPRINGS, FL 33065-5081
(775) 751-0695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
936
NV
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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