Provider Demographics
NPI:1467638668
Name:OMAR B CABAHUG MD PROF CORP
Entity type:Organization
Organization Name:OMAR B CABAHUG MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:CABAHUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-914-6994
Mailing Address - Street 1:2500 WIGWAM PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7112
Mailing Address - Country:US
Mailing Address - Phone:702-914-6994
Mailing Address - Fax:702-914-5880
Practice Address - Street 1:2500 WIGWAM PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7112
Practice Address - Country:US
Practice Address - Phone:702-914-6994
Practice Address - Fax:702-914-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018299Medicaid
NV002018299Medicaid