Healthcare Provider Details

I. General information

NPI: 1154521797
Provider Name (Legal Business Name): RONNY SARA JIJI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 N TENAYA WAY STE 100
LAS VEGAS NV
89128-0642
US

IV. Provider business mailing address

PO BOX 100744
ATLANTA GA
30384-0744
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number14007
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14007
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: