Individual
TRI TE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8205 W WARM SPRINGS RD # R210, LAS VEGAS, NV 89113-3645
(702) 534-5464
(702) 534-5465
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Q4311
TX
207RC0000X
Cardiovascular Disease Physician
Q4311
TX
207RI0011X
Interventional Cardiology Physician
Primary
DO3771
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360400105
—
TX
01
—
445253YLUJ
WELLMED MEDICAL GROUP
—
01
—
DO3771
STATE LICENSE
NV
Enumeration date
06/20/2015
Last updated
11/19/2024
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