Provider Demographics
NPI:1881706109
Name:VEGAS VALLEY PRIMARY CARE
Entity type:Organization
Organization Name:VEGAS VALLEY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-921-6829
Mailing Address - Street 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1877
Mailing Address - Country:US
Mailing Address - Phone:702-791-1326
Mailing Address - Fax:702-921-6828
Practice Address - Street 1:2810 S RAINBOW BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5150
Practice Address - Country:US
Practice Address - Phone:702-791-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37991Medicare PIN