Healthcare Provider Details

I. General information

NPI: 1629997903
Provider Name (Legal Business Name): DESERT BLOOM PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S RANCHO DR STE C1
LAS VEGAS NV
89106-3858
US

IV. Provider business mailing address

10470 W CHEYENNE AVE STE 115
LAS VEGAS NV
89129-8733
US

V. Phone/Fax

Practice location:
  • Phone: 702-846-1061
  • Fax:
Mailing address:
  • Phone: 702-846-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HAYAT JAWADI
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 702-846-1061