Healthcare Provider Details

I. General information

NPI: 1942824941
Provider Name (Legal Business Name): DEEPA HASIJA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 SPENCER ST STE 116
LAS VEGAS NV
89119-5246
US

IV. Provider business mailing address

4045 SPENCER ST STE 116
LAS VEGAS NV
89119-5246
US

V. Phone/Fax

Practice location:
  • Phone: 702-780-6200
  • Fax: 888-433-5792
Mailing address:
  • Phone: 702-780-6200
  • Fax: 888-433-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEEPA HASIJA
Title or Position: OWNER
Credential: MD
Phone: 702-780-6200