Healthcare Provider Details

I. General information

NPI: 1568719052
Provider Name (Legal Business Name): HOURY ARINE KAHWAJIAN-MOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 S EASTERN AVE #130
HENDERSON NV
89052
US

IV. Provider business mailing address

PO BOX 400310
LAS VEGAS NV
89140
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6880
  • Fax: 702-473-5455
Mailing address:
  • Phone: 310-222-2700
  • Fax: 310-533-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA128432
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number18246
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: