Basic Information
| Provider Information | |||||||||
| NPI: | 1144618349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHARWANI | ||||||||
| FirstName: | DINESH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15645 | ||||||||
| Address2: | SOUTHWEST MEDICAL ASSOCIATES | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891145645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025793298 | ||||||||
| FaxNumber: | 7026674689 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 WEST LAKE MEAD PARKWAY | ||||||||
| Address2: | SOUTHWEST MEDICAL ASSOCIATES | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026773720 | ||||||||
| FaxNumber: | 7026773733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1144618349 | 05 | NV | MEDICAID |