Provider Demographics
NPI:1881008183
Name:WESTTEAM CORP
Entity Type:Organization
Organization Name:WESTTEAM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:702-628-4649
Mailing Address - Street 1:3430 E FLAMINGO RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5003
Mailing Address - Country:US
Mailing Address - Phone:702-628-4649
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-628-4649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVV101990208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVWESTALL14OtherALL INSURANCES