Healthcare Provider Details

I. General information

NPI: 1194915785
Provider Name (Legal Business Name): DONALD C. HARTLIEB M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 JEFFREYS ST SUIT 220
HENDERSON NV
89052-4180
US

IV. Provider business mailing address

10521 JEFFREYS ST SUIT 220
HENDERSON NV
89052-4180
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-8871
  • Fax: 702-733-2177
Mailing address:
  • Phone: 702-733-8871
  • Fax: 702-733-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number5104
License Number StateNV

VIII. Authorized Official

Name: MS. TRICIA MICHELLE MALDONADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-733-8871