MEDICARE: CHARLES G MAHAKIAN MD

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366995292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES G MAHAKIAN MD

Provider Business Mailing Address
First Line	:	6881 W CHARLESTON BLVD
Second Line	:	SUITE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1673
Country	:	US
Telephone Number	:	702-258-6437
Fax Number	:	702-258-6769

Provider Business Practice Location Address
First Line	:	6881 W CHARLESTON BLVD
Second Line	:	SUITE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1673
Country	:	US
Telephone Number	:	702-258-6437
Fax Number	:	702-258-6769

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES G MAHAKIAN
Credential	:	MD
Telephone Number	:	702-823-3910

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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