Healthcare Provider Details

I. General information

NPI: 1114345345
Provider Name (Legal Business Name): ORDESSIA CHARRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD STE 320
LAS VEGAS NV
89149-4584
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD STE 320
LAS VEGAS NV
89149-4584
US

V. Phone/Fax

Practice location:
  • Phone: 702-570-3173
  • Fax:
Mailing address:
  • Phone: 702-570-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number59478
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25046
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number59478
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25046
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: