MEDICARE: MANUSHAK AVANESYAN

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1568120608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUSHAK AVANESYAN

Provider Business Mailing Address
First Line	:	9647 SOUND VIEW AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8223
Country	:	US
Telephone Number	:	818-802-6255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 MCDANIEL ST STE 140
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6308
Country	:	US
Telephone Number	:	702-633-0207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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Directions to “ MANUSHAK AVANESYAN ” Practice Location

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