Provider Demographics
NPI:1740608108
Name:A LAS VEGAS PEDIATRICS
Entity type:Organization
Organization Name:A LAS VEGAS PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-733-0744
Mailing Address - Street 1:5876 S PECOS RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3418
Mailing Address - Country:US
Mailing Address - Phone:702-733-0744
Mailing Address - Fax:702-796-8262
Practice Address - Street 1:5876 S PECOS RD BLDG B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3418
Practice Address - Country:US
Practice Address - Phone:702-733-0744
Practice Address - Fax:702-796-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care