Healthcare Provider Details

I. General information

NPI: 1285456731
Provider Name (Legal Business Name): HUANTING RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S GREEN VALLEY PKWY
HENDERSON NV
89052-0404
US

IV. Provider business mailing address

4611 LAGUNA VISTA ST
LAS VEGAS NV
89147-6042
US

V. Phone/Fax

Practice location:
  • Phone: 702-216-7101
  • Fax:
Mailing address:
  • Phone: 702-606-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24288
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: