Provider Demographics
NPI:1376143206
Name:AVETISSIAN, ARSEN
Entity Type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:AVETISSIAN
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 1:9159 W FLAMINGO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6454
Mailing Address - Country:US
Mailing Address - Phone:702-265-1100
Mailing Address - Fax:
Practice Address - Street 1:9159 W FLAMINGO RD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6454
Practice Address - Country:US
Practice Address - Phone:702-945-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker