Healthcare Provider Details

I. General information

NPI: 1922262187
Provider Name (Legal Business Name): THE SLEEP CENTER OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W CHARLESTON BLVD STE 105
LAS VEGAS NV
89146-1256
US

IV. Provider business mailing address

5701 W CHARLESTON BLVD STE 105
LAS VEGAS NV
89146-1256
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-9514
  • Fax: 702-818-2440
Mailing address:
  • Phone: 702-877-9514
  • Fax: 702-818-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number3775
License Number StateNV

VIII. Authorized Official

Name: RACHAKONDA PRABHU
Title or Position: PRESIDENT
Credential: MD
Phone: 702-877-9514