Organization
BOULDER PRIMARY & URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAN R TAITANO (PRACTICE OWNER)
(702) 509-6028
Entity
Organization
Contact information
Practice address
3468 E SAHARA AVE STE 170, LAS VEGAS, NV 89104-4827
(702) 509-6028
Mailing address
3468 E SAHARA AVE STE 170, LAS VEGAS, NV 89104-4827
(702) 509-6028
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
01/13/2025
Last updated
02/08/2025
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