Provider Demographics
NPI:1366467888
Name:ACHIN, ROWENA (MD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:ACHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 W AZURE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4431
Mailing Address - Country:US
Mailing Address - Phone:725-780-4351
Mailing Address - Fax:725-780-4339
Practice Address - Street 1:7455 W AZURE DR STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4431
Practice Address - Country:US
Practice Address - Phone:725-780-4351
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRA076914207R00000X
NV13768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4222517Medicaid
MI1101800302OtherBCBS - PIN
MI4281886Medicaid
MI4281886Medicaid
MIM43630014Medicare PIN