Healthcare Provider Details

I. General information

NPI: 1760068365
Provider Name (Legal Business Name): JIRAIR M BAGHDASSARIAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2306
US

IV. Provider business mailing address

3201 S MARYLAND PKWY STE 101
LAS VEGAS NV
89109-2423
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-5000
  • Fax:
Mailing address:
  • Phone: 702-910-6857
  • Fax: 702-703-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number838965
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: