Provider Demographics
NPI:1356431274
Name:THE PEDIATRIC CENTER
Entity type:Organization
Organization Name:THE PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-228-9066
Mailing Address - Street 1:2050 MARINER DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6656
Mailing Address - Country:US
Mailing Address - Phone:702-228-9066
Mailing Address - Fax:702-228-9416
Practice Address - Street 1:2050 MARINER DR
Practice Address - Street 2:SUITE #150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6656
Practice Address - Country:US
Practice Address - Phone:702-228-9066
Practice Address - Fax:702-228-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV7872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty