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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALFORTRA DIANE TURNER (MANAGER AGENT)
(702) 489-4503
Entity
Organization

Contact information

Practice address
1118 KRUGER CT, NORTH LAS VEGAS, NV 89032-9005
(702) 489-4503
Mailing address
1118 KRUGER CT, NORTH LAS VEGAS, NV 89032-9005
(702) 489-4503

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
NV20141299285
NV

Other

Enumeration date
04/01/2015
Last updated
04/01/2015
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