Healthcare Provider Details

I. General information

NPI: 1740529676
Provider Name (Legal Business Name): YAAKOV D KOTLARSKY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4385 N PECOS RD STE 140
LAS VEGAS NV
89115-2105
US

IV. Provider business mailing address

4385 N PECOS RD STE 140
LAS VEGAS NV
89115-2105
US

V. Phone/Fax

Practice location:
  • Phone: 702-657-0756
  • Fax:
Mailing address:
  • Phone: 702-657-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1518
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: