Individual
SURURAT A COULIBALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
630 S RANCHO DR STE E, LAS VEGAS, NV 89106-4849
(702) 258-1001
(702) 258-3455
Mailing address
2285 CORPORATE CIR, STE 200, HENDERSON, NV 89074-7759
(702) 560-2879
(702) 560-2928
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1271
NV
363AM0700X
Medical Physician Assistant
PA21484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235427816
—
NV
01
—
PA1271
MEDICAL LICENSE
NV
Enumeration date
07/15/2011
Last updated
11/02/2021
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