Provider Demographics
NPI:1093104218
Name:PAVEL GATYNYA MD LLC
Entity Type:Organization
Organization Name:PAVEL GATYNYA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GATYNYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-487-6510
Mailing Address - Street 1:PO BOX 93358
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-3358
Mailing Address - Country:US
Mailing Address - Phone:702-487-6510
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:3153 E WARM SPRINGS
Practice Address - Street 2:#300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3142
Practice Address - Country:US
Practice Address - Phone:702-487-6510
Practice Address - Fax:702-405-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty