Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11663 | NV |
NPI | 1063482180 |
---|---|
Provider Name | Roopa Dani |
First Address | Henderson, NV 89074-7760 |
Second Address | Las Vegas, NV 89148-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063482180 | (05) | NV |
H68482 | (02) |