Healthcare Provider Details

I. General information

NPI: 1134376288
Provider Name (Legal Business Name): MARK J. COLLINS, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W ROCHELLE AVE SUITE 1500
LAS VEGAS NV
89103-3376
US

IV. Provider business mailing address

6000 W ROCHELLE AVE SUITE 1500
LAS VEGAS NV
89103-3376
US

V. Phone/Fax

Practice location:
  • Phone: 702-221-2177
  • Fax: 702-221-2187
Mailing address:
  • Phone: 702-221-2177
  • Fax: 702-221-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: DR. MARK J COLLINS
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 702-221-2177