Organization
CANYON GATE MEDICAL GROUP, LLC
Active
Organization
CANYON GATE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKI MOSKOW (PRESIDENT)
(954) 656-8855
Entity
Organization
Contact information
Practice address
9280 W SUNSET RD, SUITE 426, LAS VEGAS, NV 89148-4860
(702) 262-0124
(702) 262-0143
Mailing address
2929 N UNIVERSITY DR, SUITE 110, CORAL SPRINGS, FL 33065-5081
(954) 656-8855
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12804
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396994943
—
NV
Enumeration date
09/18/2008
Last updated
04/20/2009
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