Provider Demographics
NPI:1578842373
Name:COMPREHENSIVE PSYCHIATRY OF SOUTHERN NEVADA, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHIATRY OF SOUTHERN NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-326-1116
Mailing Address - Street 1:410 S RAMPART BLVD STE 390
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5749
Mailing Address - Country:US
Mailing Address - Phone:702-326-1116
Mailing Address - Fax:702-726-6874
Practice Address - Street 1:410 S RAMPART BLVD STE 390
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5749
Practice Address - Country:US
Practice Address - Phone:702-326-1116
Practice Address - Fax:702-726-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV80622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty