Healthcare Provider Details

I. General information

NPI: 1508368317
Provider Name (Legal Business Name): TUDOR C JIANU MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 S EASTERN AVE STE 101
LAS VEGAS NV
89123-2875
US

IV. Provider business mailing address

8420 S EASTERN AVE STE 101
LAS VEGAS NV
89123-2875
US

V. Phone/Fax

Practice location:
  • Phone: 702-385-6468
  • Fax: 702-385-2663
Mailing address:
  • Phone: 702-385-6468
  • Fax: 702-385-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TUDOR C JIANU
Title or Position: PRESIDENT
Credential: MD
Phone: 702-247-8317