Provider Demographics
NPI:1467496240
Name:IRIYE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:IRIYE MEDICAL GROUP PLLC
Other - Org Name:HIGH RISK PREGNANCY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDUJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-3200
Mailing Address - Street 1:2011 PINTO LANE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:2011 PINTO LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-382-3200
Practice Address - Fax:702-382-3575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRIYE MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty