Provider Demographics
NPI:1205022258
Name:DANIELIAN, ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:DANIELIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 N TENAYA WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0642
Mailing Address - Country:US
Mailing Address - Phone:702-962-2200
Mailing Address - Fax:
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:#250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-360-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV15125207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program