Healthcare Provider Details

I. General information

NPI: 1215963756
Provider Name (Legal Business Name): PRIMARY HEALTH LINE DIAGNOSTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 E FLAMINGO RD #3
LAS VEGAS NV
89121-7440
US

IV. Provider business mailing address

2550 E DESERT INN RD #329
LAS VEGAS NV
89121-3611
US

V. Phone/Fax

Practice location:
  • Phone: 702-434-6486
  • Fax: 702-436-0060
Mailing address:
  • Phone: 702-434-6486
  • Fax: 702-436-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VALERI KARAKHANOV
Title or Position: OWNER
Credential:
Phone: 702-434-6486