Healthcare Provider Details

I. General information

NPI: 1083072425
Provider Name (Legal Business Name): NEVEDA PSYCHIATRIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 S EASTERN AVE STE C27
LAS VEGAS NV
89119-6183
US

IV. Provider business mailing address

PO BOX 72496
LAS VEGAS NV
89170-2496
US

V. Phone/Fax

Practice location:
  • Phone: 702-365-9006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7977
License Number StateNV

VIII. Authorized Official

Name: SALEHA K BAIG
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 702-686-4469