Provider Demographics
NPI:1265639793
Name:PURAYIL, PREEMA P (MD)
Entity Type:Individual
Prefix:DR
First Name:PREEMA
Middle Name:P
Last Name:PURAYIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2419
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1397 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6661
Practice Address - Country:US
Practice Address - Phone:702-436-5800
Practice Address - Fax:702-436-2420
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1265639793Medicaid
NV1265639793Medicaid
NVEV446ZMedicare PIN