Provider Demographics
NPI:1750586038
Name:HALTHORE JOHNS PEDIATRIC NEUROLOGY
Entity type:Organization
Organization Name:HALTHORE JOHNS PEDIATRIC NEUROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALTHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-796-5505
Mailing Address - Street 1:2020 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3211
Mailing Address - Country:US
Mailing Address - Phone:702-796-5505
Mailing Address - Fax:702-732-9830
Practice Address - Street 1:2020 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3211
Practice Address - Country:US
Practice Address - Phone:702-796-5505
Practice Address - Fax:702-732-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730119413OtherINDIVIDUAL NPI (HALTHORE)
NV1326078098OtherINDIVIDUAL NPI (MALLER)
NV1780615013OtherINDIVIDUAL NPI (JOHNS)
NV1780615013OtherINDIVIDUAL NPI (JOHNS)