MEDICARE: THE PEDIATRIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	NV7872	NV

General Provider Information

NPI Number	:	1356431274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PEDIATRIC CENTER

Provider Business Mailing Address
First Line	:	2050 MARINER DR
Second Line	:	SUITE #150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6656
Country	:	US
Telephone Number	:	702-228-9066
Fax Number	:	702-228-9416

Provider Business Practice Location Address
First Line	:	2050 MARINER DR
Second Line	:	SUITE #150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6656
Country	:	US
Telephone Number	:	702-228-9066
Fax Number	:	702-228-9416

Authorized Official
Title or Position	:	OWNER
Name	:	SHAZIA A KIRMANI
Credential	:	MD
Telephone Number	:	702-228-9066

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/22/2020

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Directions to “THE PEDIATRIC CENTER ” Practice Location

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