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9082 Vintage Wine Ave Las Vegas NV 89148-4916 | |
| (702) 328-0459 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Exercise & Sports |
| Location | 9082 Vintage Wine Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Jude Niba (PRESIDENT) |
| Authorized Official Contact | 7023280459 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9082 Vintage Wine Ave Las Vegas NV 89148-4916 Ph: (702) 328-0459 | 9082 Vintage Wine Ave Las Vegas NV 89148-4916 Ph: (702) 328-0459 |
| NPI Number | 1790282002 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 04/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790282002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TE1100X | Psychologist - Exercise & Sports | 667 (Nevada) | Primary |
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