Healthcare Provider Details

I. General information

NPI: 1275773020
Provider Name (Legal Business Name): NALINI VELAYUDHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 NEVADA HWY SUITE A
BOULDER CITY NV
89005-1853
US

IV. Provider business mailing address

1297 NEVADA HWY SUITE A
BOULDER CITY NV
89005-1853
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-1919
  • Fax: 702-294-0072
Mailing address:
  • Phone: 702-294-1919
  • Fax: 702-294-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FALVO
Title or Position: PHYSICIAN/OWNER
Credential: M.D,
Phone: 702-294-1919