Healthcare Provider Details

I. General information

NPI: 1225196447
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 SIENA HEIGHTS DR SUITE 331-A
HENDERSON NV
89052-4167
US

IV. Provider business mailing address

2865 SIENA HEIGHTS DR SUITE 331-A
HENDERSON NV
89052-4167
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-8224
  • Fax: 702-990-8738
Mailing address:
  • Phone: 702-731-8224
  • Fax: 702-990-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUANN M FILLION
Title or Position: CREDENTIALING SPECIALIST
Credential: 7026919110
Phone: 702-691-9110