Basic Information
| Provider Information | |||||||||
| NPI: | 1588058044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANESAN | ||||||||
| FirstName: | RAJIV | ||||||||
| MiddleName: | JEYAKUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 FIRE MESA ST | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891289016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029926875 | ||||||||
| FaxNumber: | 7029926878 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 FIRE MESA ST | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029926875 | ||||||||
| FaxNumber: | 7029926878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2015 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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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 | 207Q00000X | 18053 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.