Healthcare Provider Details

I. General information

NPI: 1396821963
Provider Name (Legal Business Name): BEATA A TARATUTA MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD SUIET 2-153
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD SUIET 2-153
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 702-477-7044
  • Fax: 702-388-1664
Mailing address:
  • Phone: 702-477-7044
  • Fax: 702-388-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9441
License Number StateNV

VIII. Authorized Official

Name: BEATA ANNA TARATUTA
Title or Position: OWNER
Credential: MD
Phone: 702-477-7044