Healthcare Provider Details

I. General information

NPI: 1427633510
Provider Name (Legal Business Name): MAHAKIAN CHARLES G
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6857 W CHARLESTON BLVD
LAS VEGAS NV
89117-1600
US

IV. Provider business mailing address

6857 W CHARLESTON BLVD
LAS VEGAS NV
89117-1600
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-6437
  • Fax:
Mailing address:
  • Phone: 702-258-6437
  • Fax: 702-258-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES G MAHAKIAN
Title or Position: CEO
Credential: MD
Phone: 702-258-6437