Healthcare Provider Details

I. General information

NPI: 1962712828
Provider Name (Legal Business Name): EID NEVADA CRITICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 07/30/2019
Certification Date:
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: 702-946-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WAEL EID
Title or Position: PRESIDENT
Credential: MD
Phone: 702-476-4900