Healthcare Provider Details

I. General information

NPI: 1093772204
Provider Name (Legal Business Name): AGATA-VENGER PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 S. MARYLAND PARKWAY SUITE #200
LAS VEGAS NV
89109-6227
US

IV. Provider business mailing address

3061 S. MARYLAND PARKWAY SUITE #200
LAS VEGAS NV
89109-6227
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-1948
  • Fax: 702-735-0742
Mailing address:
  • Phone: 702-737-1948
  • Fax: 702-735-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: DEBRA HARPER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 702-737-1948