MEDICARE: PANNU TOTS TO TEENS PEDIATRIC OFFICE

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	7247	NV

General Provider Information

NPI Number	:	1619273356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANNU TOTS TO TEENS PEDIATRIC OFFICE

Provider Business Mailing Address
First Line	:	9312 RED TWIG DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-1810
Country	:	US
Telephone Number	:	702-639-3540
Fax Number	:	702-639-3542

Provider Business Practice Location Address
First Line	:	2501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2127
Country	:	US
Telephone Number	:	702-639-3540
Fax Number	:	702-639-3540

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. PREETI K BAJWA
Credential	:
Telephone Number	:	702-743-1706

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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