Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 16728 | NV |
Y | 208000000X | Pediatrician | A138329 | CA |
NPI | 1235471061 |
---|---|
Provider Name | Dr. Reshma Ambaram |
First Address | Las Vegas, NV 89102-2227 |
Second Address | Las Vegas, NV 89102-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 20/12/2016 |