Healthcare Provider Details

I. General information

NPI: 1821076092
Provider Name (Legal Business Name): HOLLY H. HOBART PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W. CHARLESTON BLVD- DBA NEVADA GENETICS LABORATORY 110-B
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

2040 W CHARLESTON BLVD 202-A
LAS VEGAS NV
89102-2227
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5055
  • Fax: 702-671-0193
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number16016 DIR-0
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License Number16016 DIR-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: