Provider Demographics
NPI:1730206780
Name:UNIVERSITY OF NV SCHOOL ASSOCIATES SOUTH GROUP PRACTICE SO
Entity type:Organization
Organization Name:UNIVERSITY OF NV SCHOOL ASSOCIATES SOUTH GROUP PRACTICE SO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAMBONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-671-2278
Mailing Address - Street 1:PO BOX 98528
Mailing Address - Street 2:DEPT 401
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8528
Mailing Address - Country:US
Mailing Address - Phone:702-731-9110
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:880 SEVEN HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4371
Practice Address - Country:US
Practice Address - Phone:702-836-1221
Practice Address - Fax:702-614-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWQBHVMedicare PIN