Organization
INTEGRATED MULTI SPECIALTY MEDICAL GROUP
Active
Organization
INTEGRATED MULTI SPECIALTY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE CARILLO (CREDENTIALING)
(702) 569-7244
Entity
Organization
Contact information
Practice address
1440 E NEVADA HIGHWAY 372 STE 3, PAHRUMP, NV 89048-2184
(702) 483-3630
Mailing address
801 S RANCHO DR STE A2, LAS VEGAS, NV 89106-3870
(702) 483-3630
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/01/2022
Last updated
02/01/2022
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