Provider Demographics
NPI:1942945340
Name:VEGAS PEDIATRIC PARTNERS
Entity Type:Organization
Organization Name:VEGAS PEDIATRIC PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAZZALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-456-0005
Mailing Address - Street 1:5642 S EASTERN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2310
Mailing Address - Country:US
Mailing Address - Phone:702-508-0755
Mailing Address - Fax:702-659-7116
Practice Address - Street 1:5642 S EASTERN AVE STE F
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2310
Practice Address - Country:US
Practice Address - Phone:702-508-0755
Practice Address - Fax:702-659-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty