Organization
CANYON GATE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKI MOSKOW (PRESIDENT)
(954) 656-8855
Entity
Organization
Contact information
Practice address
283 N PECOS RD, HENDERSON, NV 89074-1918
(702) 430-3570
Mailing address
2929 N UNIVERSITY DR, SUITE # 110, CORAL SPRINGS, FL 33065-5081
(954) 656-8855
(954) 656-8856
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12804
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831347731
—
NV
Enumeration date
02/04/2010
Last updated
02/04/2010
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