Healthcare Provider Details

I. General information

NPI: 1366068041
Provider Name (Legal Business Name): MEDICAL GENETICS OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2538 ANTHEM VILLAGE DR STE 110
HENDERSON NV
89052-5551
US

IV. Provider business mailing address

2538 ANTHEM VILLAGE DR STE 110
HENDERSON NV
89052-5551
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-6800
  • Fax: 702-932-9611
Mailing address:
  • Phone: 702-732-6800
  • Fax: 702-932-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSANNA SORRENTINO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 702-732-6800