Healthcare Provider Details

I. General information

NPI: 1164474292
Provider Name (Legal Business Name): DESERT ALLERGY, ASTHMA & IMMUNOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 W HORIZON RIDGE PKWY #101
HENDERSON NV
89052-4427
US

IV. Provider business mailing address

129 W LAKE MEAD PKWY #B-18
HENDERSON NV
89015-7055
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-4440
  • Fax: 702-558-1522
Mailing address:
  • Phone: 702-564-4440
  • Fax: 702-558-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: A SEAN MCKNIGHT
Title or Position: CORPORATE PARTNER
Credential: MD
Phone: 702-564-4440