Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 19139 | NV |
NPI | 1205276250 |
---|---|
Provider Name | Dr. Mais Yacoub |
First Address | Las Vegas, NV 89137-1540 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 31/07/2019 |