Healthcare Provider Details

I. General information

NPI: 1396018511
Provider Name (Legal Business Name): SUBA PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E SAHARA AVE
LAS VEGAS NV
89104-3439
US

IV. Provider business mailing address

1530 E SAHARA AVE
LAS VEGAS NV
89104-3439
US

V. Phone/Fax

Practice location:
  • Phone: 845-659-6317
  • Fax: 702-566-4575
Mailing address:
  • Phone: 845-659-6317
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13792
License Number StateNV

VIII. Authorized Official

Name: FAISAL SUBA
Title or Position: OWNER
Credential: MD
Phone: 702-685-0674