Basic Information
| Provider Information | |||||||||
| NPI: | 1811429426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOSTAK | ||||||||
| FirstName: | TRITIA | ||||||||
| MiddleName: | LANKHANH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S RANCHO DR | ||||||||
| Address2: | STE 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S RANCHO DR STE 12 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2017 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | DO3186 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.