Provider Demographics
NPI:1003086273
Name:OSHIRO PEDIATRICS, LLC
Entity Type:Organization
Organization Name:OSHIRO PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:OSHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-733-6033
Mailing Address - Street 1:PO BOX 71806
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89170-1806
Mailing Address - Country:US
Mailing Address - Phone:702-733-6033
Mailing Address - Fax:702-892-9567
Practice Address - Street 1:4570 S EASTERN AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6183
Practice Address - Country:US
Practice Address - Phone:702-733-6033
Practice Address - Fax:702-892-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC0722OtherBLUE SHIELD
NVNV5068OtherBLUE SHIELD
NVCC1232OtherBLUE SHIELD
NV34617Medicare PIN
NVCC0722OtherBLUE SHIELD
NVNV5068OtherBLUE SHIELD