Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | B610 | NV |
NPI | 1992867287 |
---|---|
Provider Name | Dr. Sam Dominic Colarusso |
First Address | Las Vegas, NV 89117-2760 |
Second Address | Las Vegas, NV 89113-2170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 23/06/2017 |