Healthcare Provider Details

I. General information

NPI: 1578767836
Provider Name (Legal Business Name): DHANVANTARI TREHAN SALTS OF THE EARTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR SUITE # 400
LAS VEGAS NV
89144-0514
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD SUITE # 2278
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 702-343-3522
  • Fax: 702-877-3376
Mailing address:
  • Phone: 702-343-3522
  • Fax: 702-877-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number11042
License Number StateNV

VIII. Authorized Official

Name: DR. MANJU MONIKA TREHAN
Title or Position: CORPORATE DESIGNEE
Credential: MD
Phone: 702-343-3522