Healthcare Provider Details

I. General information

NPI: 1629054994
Provider Name (Legal Business Name): LAS VEGAS UROLOGY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W SUNSET RD STE 202B
LAS VEGAS NV
89113-1981
US

IV. Provider business mailing address

7150 W SUNSET RD STE 200
LAS VEGAS NV
89113-1982
US

V. Phone/Fax

Practice location:
  • Phone: 702-385-4342
  • Fax: 702-385-4346
Mailing address:
  • Phone: 702-385-4342
  • Fax: 702-385-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTOR E. GRIGORIEV
Title or Position: MNG MBR
Credential: MD
Phone: 702-233-0727