Provider Demographics
NPI:1295711372
Name:JURANI LLC
Entity type:Organization
Organization Name:JURANI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATERNO
Authorized Official - Middle Name:S
Authorized Official - Last Name:JURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-258-4900
Mailing Address - Street 1:633 N DECATUR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1943
Mailing Address - Country:US
Mailing Address - Phone:702-258-4900
Mailing Address - Fax:702-258-5006
Practice Address - Street 1:633 N DECATUR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1943
Practice Address - Country:US
Practice Address - Phone:702-258-4900
Practice Address - Fax:702-258-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019515Medicaid
NVC37232Medicare UPIN
NV37022Medicare ID - Type Unspecified