Healthcare Provider Details

I. General information

NPI: 1427996636
Provider Name (Legal Business Name): VICTOR MANUEL CARVAJAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

IV. Provider business mailing address

248 AUTUMN EVE ST
HENDERSON NV
89074-7837
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2000
  • Fax:
Mailing address:
  • Phone: 702-467-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: