Healthcare Provider Details

I. General information

NPI: 1619671658
Provider Name (Legal Business Name): LAS VEGAS PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S RAINBOW BLVD STE 10
LAS VEGAS NV
89118-2503
US

IV. Provider business mailing address

6070 S RAINBOW BLVD UNIT 10
LAS VEGAS NV
89118-2503
US

V. Phone/Fax

Practice location:
  • Phone: 702-420-7222
  • Fax: 702-331-6018
Mailing address:
  • Phone: 504-250-8911
  • Fax: 702-331-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MIMI KURIAKOSE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 504-250-8911