Organization
MUJICA TRENCHE - VITALITY MD PC
Active
Other names
Stockridge Men's MedCenter
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL A MUJICA TRENCHE MD (SOLE MEMBER)
(702) 888-0052
Entity
Organization
Contact information
Practice address
6380 W FLAMINGO RD, STE A, LAS VEGAS, NV 89103-7129
(702) 888-0052
Mailing address
PO BOX 521, ANDOVER, KS 67002-0521
(316) 927-3884
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
11/19/2011
Last updated
03/16/2012
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