Provider Demographics
NPI:1689212045
Name:GHANEIAN PEDIATRIC CARE, INC.
Entity Type:Organization
Organization Name:GHANEIAN PEDIATRIC CARE, INC.
Other - Org Name:HEALTHY KIDS CARE AT SUNRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-444-7685
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 411
Mailing Address - Street 2:SUNRISE MEDICAL TOWER IV
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2318
Mailing Address - Country:US
Mailing Address - Phone:702-444-7685
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY STE 411
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2318
Practice Address - Country:US
Practice Address - Phone:310-561-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty