Provider Demographics
NPI:1497097018
Name:WANG, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E SAHARA AVE
Mailing Address - Street 2:#212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3741
Mailing Address - Country:US
Mailing Address - Phone:702-901-4964
Mailing Address - Fax:702-892-8193
Practice Address - Street 1:7180 CASCADE VALLEY CT
Practice Address - Street 2:#180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0449
Practice Address - Country:US
Practice Address - Phone:702-901-4964
Practice Address - Fax:702-892-8193
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16462208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics