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Individual

O'BRODERIC MYTIAWO SANDERS II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1516 E TROPICANA AVE, LAS VEGAS, NV 89119-6525
(702) 586-9674
Mailing address
6624 BROOKLYN HEIGHTS ST, LAS VEGAS, NV 89166-8020
(702) 340-9229

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
10/16/2017
Last updated
10/16/2017
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