Basic Information
| Provider Information | |||||||||
| NPI: | 1104859545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRASADLEELA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3022 S DURANGO DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891174439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023416699 | ||||||||
| FaxNumber: | 7023416968 | ||||||||
| Practice Location | |||||||||
| Address1: | 7106 SMOKE RANCH RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891288306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023416699 | ||||||||
| FaxNumber: | 7023416968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | KESHAVA-PRASAD | ||||||||
| AuthorizedOfficialFirstName: | HOLAVANAHALLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7023416699 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 8823 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.