Healthcare Provider Details

I. General information

NPI: 1598206849
Provider Name (Legal Business Name): SUBHIKSHYA TIWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE # A955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

10624 S EASTERN AVE # A955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-5393
  • Fax: 702-407-7016
Mailing address:
  • Phone: 702-800-5393
  • Fax: 702-407-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19702
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number19702
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA163820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: