Individual
TAYLOR RAEANNE FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 BREAKTHROUGH WAY, LAS VEGAS, NV 89135-3011
(702) 732-1493
(702) 732-1080
Mailing address
10170 W TROPICANA AVE # 156-252, LAS VEGAS, NV 89147-8465
(702) 732-1493
(702) 732-1080
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2787
NV
Other
Enumeration date
10/05/2022
Last updated
03/16/2023
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