| Canyon Gate Medical Group, Llc | |
|
9280 W Sunset Rd Suite 426 Las Vegas NV 89148-4860 | |
| (702) 262-0124 | |
| (702) 262-0143 |
| Full Name | Canyon Gate Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9280 W Sunset Rd, Las Vegas, Nevada |
| Authorized Official Name and Position | Ricki Moskow (PRESIDENT) |
| Authorized Official Contact | 9546568855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Gate Medical Group, Llc 2929 N University Dr Suite 110 Coral Springs FL 33065-5081 Ph: (954) 656-8855 | Canyon Gate Medical Group, Llc 9280 W Sunset Rd Suite 426 Las Vegas NV 89148-4860 Ph: (702) 262-0124 |
| NPI Number | 1396994943 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 04/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396994943 | NPI | - | NPPES |
| 1396994943 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 12804 (Nevada) | Primary |
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