Basic Information
| Provider Information | |||||||||
| NPI: | 1154707925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASKEN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 CORONADO CENTER DR STE 211 | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024078241 | ||||||||
| FaxNumber: | 7024921728 | ||||||||
| Practice Location | |||||||||
| Address1: | 3186 S MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182810294 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | STEFANOVA | ||||||||
| AuthorizedOfficialFirstName: | NINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8182810294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15725 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.