Organization
DOYNE MEDICAL CLINIC INC., APC
Active
Organization
DOYNE MEDICAL CLINIC INC., APC
Active
Other names
Doyne Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO OLIVER TABLANTE GODOY CNP (MEDICAL DIRECTOR)
(702) 631-6860
Entity
Organization
Contact information
Practice address
1706 W BONANZA RD, LAS VEGAS, NV 89106-4704
(702) 631-6860
(702) 631-6864
Mailing address
1706 W BONANZA RD, LAS VEGAS, NV 89106-4704
(702) 631-6860
(702) 631-6864
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019446
—
NV
Enumeration date
08/08/2006
Last updated
08/28/2026
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