Healthcare Provider Details

I. General information

NPI: 1265688105
Provider Name (Legal Business Name): RITA GHUTAI SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GHUTAI RITA MAHIR M.D.

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SHADOW LN STE 200
LAS VEGAS NV
89106-4195
US

IV. Provider business mailing address

701 SHADOW LN STE 200
LAS VEGAS NV
89106-4195
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2691
  • Fax: 702-388-4114
Mailing address:
  • Phone: 702-383-2691
  • Fax: 702-388-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15366
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number15366
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: