Healthcare Provider Details

I. General information

NPI: 1235224361
Provider Name (Legal Business Name): NIKOGOSIAN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 S RAINBOW BLVD SUITE 306
LAS VEGAS NV
89118-1800
US

IV. Provider business mailing address

5380 S RAINBOW BLVD SUITE 306
LAS VEGAS NV
89118-1800
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-9930
  • Fax: 702-362-9954
Mailing address:
  • Phone: 702-362-9930
  • Fax: 702-362-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10614
License Number StateNV

VIII. Authorized Official

Name: ARMEN NIKOGOSIAN
Title or Position: OWNER
Credential: MD
Phone: 702-362-9930