Provider Demographics
NPI:1164474292
Name:DESERT ALLERGY, ASTHMA & IMMUNOLOGY, LLP
Entity Type:Organization
Organization Name:DESERT ALLERGY, ASTHMA & IMMUNOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-564-4440
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:#B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY
Practice Address - Street 2:#101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4427
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:702-558-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV40642Medicare PIN
NVDG1879Medicare PIN