Provider Demographics
NPI:1497781330
Name:HANI, PEDRO J (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:HANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-382-2919
Mailing Address - Fax:702-474-0620
Practice Address - Street 1:4 SUNSET WAY
Practice Address - Street 2:SUITE A-3
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2015
Practice Address - Country:US
Practice Address - Phone:702-434-9690
Practice Address - Fax:702-436-7266
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3114207RP1001X
NV7694207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115395905Medicaid
NV7694OtherMEDICAL LICENSE
TX115395906Medicaid
TX115395904Medicaid
TX8S3100OtherBC/BS
TXP000185892OtherRR MEDICARE
TX8B9329Medicare PIN
TX8K5093Medicare PIN
TXF50292Medicare UPIN
TX8S3100OtherBC/BS