Healthcare Provider Details

I. General information

NPI: 1528881612
Provider Name (Legal Business Name): HENDERSON CANCER CENTER AND BLOOD DISORDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 S PECOS RD STE 23A
HENDERSON NV
89074-7148
US

IV. Provider business mailing address

2267 CANDLESTICK AVE
HENDERSON NV
89052-2361
US

V. Phone/Fax

Practice location:
  • Phone: 702-361-3030
  • Fax: 702-361-3031
Mailing address:
  • Phone: 702-361-3030
  • Fax: 702-361-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMDY A MOHTASEB
Title or Position: OWNER
Credential: MD
Phone: 928-279-3838