Healthcare Provider Details

I. General information

NPI: 1306191994
Provider Name (Legal Business Name): JORDANA NOREEN CHETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N TENAYA WAY
LAS VEGAS NV
89128-0482
US

IV. Provider business mailing address

286 ELDER VIEW DR
LAS VEGAS NV
89138-5011
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-3333
  • Fax:
Mailing address:
  • Phone: 702-504-0283
  • Fax: 702-483-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101257972
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17559
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number17559
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: