Provider Demographics
NPI:1629607940
Name:PACIFIC WEST UROLOGY LLC A PROFESSIONAL MEDICAL COMPANY
Entity Type:Organization
Organization Name:PACIFIC WEST UROLOGY LLC A PROFESSIONAL MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-715-4155
Mailing Address - Street 1:4313 CORAN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2844
Mailing Address - Country:US
Mailing Address - Phone:702-715-4155
Mailing Address - Fax:
Practice Address - Street 1:6110 ELTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2538
Practice Address - Country:US
Practice Address - Phone:702-906-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty