Healthcare Provider Details

I. General information

NPI: 1649114612
Provider Name (Legal Business Name): NICHOLAS DIRASIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LUMINOSO ST
LAS VEGAS NV
89138-4528
US

IV. Provider business mailing address

715 LUMINOSO ST
LAS VEGAS NV
89138-4528
US

V. Phone/Fax

Practice location:
  • Phone: 702-701-2503
  • Fax:
Mailing address:
  • Phone: 702-701-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number845908
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: