Healthcare Provider Details

I. General information

NPI: 1952402810
Provider Name (Legal Business Name): MIRELA MALEVANOV MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 S EASTERN AVE STE 200
LAS VEGAS NV
89123-2545
US

IV. Provider business mailing address

8275 S EASTERN AVE STE 200
LAS VEGAS NV
89123-2545
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-6200
  • Fax: 702-458-6117
Mailing address:
  • Phone: 702-483-6200
  • Fax: 702-458-6117

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: MIRELA C MALEVANOV
Title or Position: PRESIDENT
Credential: MD
Phone: 702-483-6200