Healthcare Provider Details

I. General information

NPI: 1255452785
Provider Name (Legal Business Name): GEORGE MED PEDS ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6252 S RAINBOW BLVD SUITE 110
LAS VEGAS NV
89118-3248
US

IV. Provider business mailing address

2725 S JONES BLVD SUITE 100
LAS VEGAS NV
89146-5605
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-5410
  • Fax: 702-433-5410
Mailing address:
  • Phone: 702-253-5410
  • Fax: 702-433-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11122
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11122
License Number StateNV

VIII. Authorized Official

Name: DR. CONSTANTINE GEORGE
Title or Position: OWNER
Credential: M.D.
Phone: 702-253-5410