Provider Demographics
NPI:1811055627
Name:MOGLER, MIROSLAVA (MD)
Entity type:Individual
Prefix:DR
First Name:MIROSLAVA
Middle Name:
Last Name:MOGLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5751 S FORT APACHE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5624
Mailing Address - Country:US
Mailing Address - Phone:702-939-0480
Mailing Address - Fax:702-939-0482
Practice Address - Street 1:5751 S FORT APACHE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5624
Practice Address - Country:US
Practice Address - Phone:702-939-0480
Practice Address - Fax:702-939-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3102895Medicaid
NV3102895Medicaid