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
03/09/2026
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