Healthcare Provider Details

I. General information

NPI: 1205276250
Provider Name (Legal Business Name): MAIS YACOUB M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

PO BOX 371540
LAS VEGAS NV
89137-1540
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2420
  • Fax:
Mailing address:
  • Phone: 702-383-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number73991
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number19139
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: