Healthcare Provider Details

I. General information

NPI: 1003023508
Provider Name (Legal Business Name): VIREN B PATEL DO A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 SMOKE RANCH RD SUITE 120
LAS VEGAS NV
89128-3123
US

IV. Provider business mailing address

2800 COAST LINE CT
LAS VEGAS NV
89117-3522
US

V. Phone/Fax

Practice location:
  • Phone: 702-477-7044
  • Fax: 702-259-4843
Mailing address:
  • Phone: 702-453-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number883
License Number StateNV

VIII. Authorized Official

Name: LORI A LABRECQUE
Title or Position: ACCTS. MGR
Credential:
Phone: 702-453-3799