Healthcare Provider Details

I. General information

NPI: 1912561358
Provider Name (Legal Business Name): RAVNEET SINGH RANDHAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5613
US

IV. Provider business mailing address

1801 W OLYMPIC BLVD # 1270
PASADENA CA
91199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-4900
  • Fax:
Mailing address:
  • Phone: 702-476-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number29229
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number29229
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: