Healthcare Provider Details

I. General information

NPI: 1427012806
Provider Name (Legal Business Name): ALKA PETER REBENTISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6088 S DURANGO DR STE 100
LAS VEGAS NV
89113-1780
US

IV. Provider business mailing address

1450 W HORIZON RIDGE PKWY B304 #668
HENDERSON NV
89012
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-4242
  • Fax: 702-380-4141
Mailing address:
  • Phone: 702-380-4242
  • Fax: 702-380-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number8061
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: