Healthcare Provider Details

I. General information

NPI: 1467018309
Provider Name (Legal Business Name): VITALIY TURBIN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N TENAYA WAY
LAS VEGAS NV
89128-0427
US

IV. Provider business mailing address

2653 N MORELAND BLVD APT 17
SHAKER HEIGHTS OH
44120-1400
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-4950
  • Fax: 702-473-7158
Mailing address:
  • Phone: 216-556-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number819187
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: