Healthcare Provider Details

I. General information

NPI: 1235189705
Provider Name (Legal Business Name): JOHN VARTAN ANOOSHIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E. CHARLESTON BLVD. #B-130
LAS VEGAS NV
89104
US

IV. Provider business mailing address

1701 W. CHARLESTON BLVD. SUITE 670. ATTN: SANDRA EROSA, CREDENTIALING SPECIALIST
LAS VEGAS NV
89102-2343
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-4000
  • Fax:
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8520
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: