Provider Demographics
NPI:1275254492
Name:MAHMOOD, KATLIN AIDEN (PAC)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:AIDEN
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 N MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-874-4769
Mailing Address - Fax:
Practice Address - Street 1:4060 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 101A
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-874-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2678363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty