Provider Demographics
NPI:1225741804
Name:KARAPETYAN, AGA VICK
Entity Type:Individual
Prefix:MR
First Name:AGA
Middle Name:VICK
Last Name:KARAPETYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 S RAINBOW BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6208
Mailing Address - Country:US
Mailing Address - Phone:702-955-1261
Mailing Address - Fax:
Practice Address - Street 1:3311 S RAINBOW BLVD STE 145
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6208
Practice Address - Country:US
Practice Address - Phone:702-955-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV82-26209962Medicaid