Healthcare Provider Details

I. General information

NPI: 1972063410
Provider Name (Legal Business Name): AMANPREET SINGH PAUL PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103
US

IV. Provider business mailing address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax:
Mailing address:
  • Phone: 702-485-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: