Healthcare Provider Details

I. General information

NPI: 1801826086
Provider Name (Legal Business Name): ARMEN HOVANESSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PALOMINO LN STE 100
LAS VEGAS NV
89106-4894
US

IV. Provider business mailing address

2020 PALOMINO LN # 100
LAS VEGAS NV
89106-4894
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-8600
  • Fax: 702-384-1815
Mailing address:
  • Phone: 702-759-8600
  • Fax: 702-384-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10176
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: