Provider Demographics
NPI:1881970515
Name:CHOHLIDAKIS, MARIA RACHEL (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:RACHEL
Last Name:CHOHLIDAKIS
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 1:10105 BANBURRY CROSS DRIVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6649
Mailing Address - Country:US
Mailing Address - Phone:702-260-4525
Mailing Address - Fax:702-869-0133
Practice Address - Street 1:10105 BANBURRY CROSS DRIVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6649
Practice Address - Country:US
Practice Address - Phone:702-260-4525
Practice Address - Fax:702-869-0133
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2015-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA121396208000000X
NV1559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53955FMedicaid
CAGR0089250Medicaid
CARHM53955FMedicaid
CAZZZ20791ZMedicare Oscar/Certification
CA553957Medicare PIN
CA553955Medicare PIN