Healthcare Provider Details

I. General information

NPI: 1730375262
Provider Name (Legal Business Name): LAS VEGAS DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N. TOWN CENTER DRIVE STE #410
LAS VEGAS NV
89144
US

IV. Provider business mailing address

653 N TOWN CENTER DR STE 414
LAS VEGAS NV
89144-0518
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-3120
  • Fax: 702-823-1069
Mailing address:
  • Phone: 702-456-3120
  • Fax: 702-823-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberE0492222006-0
License Number StateNV

VIII. Authorized Official

Name: MRS. LESLIE ANN MCSHARRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-456-3120