Provider Demographics
NPI:1376118679
Name:KHAMO, GEORGE MARDEROSIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARDEROSIAN
Last Name:KHAMO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 WEST HORIZON RIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5075
Mailing Address - Country:US
Mailing Address - Phone:702-564-8556
Mailing Address - Fax:702-564-4485
Practice Address - Street 1:2350 WEST HORIZON RIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5075
Practice Address - Country:US
Practice Address - Phone:702-564-8556
Practice Address - Fax:702-564-4485
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant