Basic Information
| Provider Information | |||||||||
| NPI: | 1881706109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VEGAS VALLEY PRIMARY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5380 S RAINBOW BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891181877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027911326 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Practice Location | |||||||||
| Address1: | 2810 S RAINBOW BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027911326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAXENA | ||||||||
| AuthorizedOfficialFirstName: | ALOK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7029216829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.