Provider Demographics
NPI:1952589541
Name:NICOLE J. MOSS, M.D., LTD.
Entity Type:Organization
Organization Name:NICOLE J. MOSS, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JULIANA
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-242-2782
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:702-233-2123
Mailing Address - Fax:702-233-0398
Practice Address - Street 1:2931 N TENAYA WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0456
Practice Address - Country:US
Practice Address - Phone:702-233-2123
Practice Address - Fax:702-233-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9708207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty