Provider Demographics
NPI:1821341363
Name:BHUSHAN MANJOORAN WIRJO & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BHUSHAN MANJOORAN WIRJO & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-417-4091
Mailing Address - Street 1:PO BOX 371598
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1598
Mailing Address - Country:US
Mailing Address - Phone:702-417-4091
Mailing Address - Fax:702-527-7545
Practice Address - Street 1:3100 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0436
Practice Address - Country:US
Practice Address - Phone:702-417-4091
Practice Address - Fax:702-527-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO17162084P0800X
NV123712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty