Healthcare Provider Details

I. General information

NPI: 1487817110
Provider Name (Legal Business Name): BEENA THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 S EASTERN AVE SUITE 100
HENDERSON NV
89052-4195
US

IV. Provider business mailing address

PO BOX 98820
LAS VEGAS NV
89193-8820
US

V. Phone/Fax

Practice location:
  • Phone: 702-914-7150
  • Fax: 702-492-1728
Mailing address:
  • Phone: 702-914-7150
  • Fax: 702-492-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA725
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: