Basic Information
Provider Information
NPI: 1710588314
EntityType: 2
ReplacementNPI:  
OrganizationName: VITUITY - NEVADA KOURY & PARTNERS PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 POWELL ST STE 400
Address2:  
City: EMERYVILLE
State: CA
PostalCode: 946081826
CountryCode: US
TelephoneNumber: 5103502600
FaxNumber:  
Practice Location
Address1: 880 ALDER AVE
Address2:  
City: INCLINE VILLAGE
State: NV
PostalCode: 894518335
CountryCode: US
TelephoneNumber: 7758334100
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/02/2020
LastUpdateDate: 02/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KOURY
AuthorizedOfficialFirstName: THEOPHILE
AuthorizedOfficialMiddleName: G.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5108517411
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


Home