Healthcare Provider Details

I. General information

NPI: 1609155894
Provider Name (Legal Business Name): REYNALD FERRAZ, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 WIGWAM PKWY SUITE 100
HENDERSON NV
89074-8162
US

IV. Provider business mailing address

2646 COTTONWILLOW ST
LAS VEGAS NV
89135-2600
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-0201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20111514344
License Number StateNV

VIII. Authorized Official

Name: REYNALD FERRAZ
Title or Position: MANAGER
Credential: M.D.
Phone: 702-943-8820