Healthcare Provider Details

I. General information

NPI: 1306908470
Provider Name (Legal Business Name): WAEL EID MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR STE 202
LAS VEGAS NV
89144-0516
US

IV. Provider business mailing address

1801 W OLYMPIC BLVD # 1220
PASADENA CA
91199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-6694
  • Fax: 702-233-0485
Mailing address:
  • Phone: 702-233-6694
  • Fax: 702-233-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WAEL EID
Title or Position: PRESIDENT
Credential: MD
Phone: 702-233-6694