Provider Demographics
NPI:1629397690
Name:PEDRO P HANI MD PC
Entity Type:Organization
Organization Name:PEDRO P HANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:P
Authorized Official - Last Name:HANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-544-7198
Mailing Address - Street 1:8255 LAS VEGAS BLVD S
Mailing Address - Street 2:UNIT 1719
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1064
Mailing Address - Country:US
Mailing Address - Phone:469-544-7198
Mailing Address - Fax:
Practice Address - Street 1:8255 LAS VEGAS BLVD S
Practice Address - Street 2:UNIT 1719
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1064
Practice Address - Country:US
Practice Address - Phone:469-544-7198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7694207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7694OtherNV MEDICAL LICENSE
NVF50292Medicare UPIN