Healthcare Provider Details

I. General information

NPI: 1316283732
Provider Name (Legal Business Name): DINA V PATEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 PINTO LN 3RD. FLOOR
LAS VEGAS NV
89106-4195
US

IV. Provider business mailing address

1524 PINTO LN 2ND. FLOOR
LAS VEGAS NV
89106-4195
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2828
  • Fax: 702-944-2852
Mailing address:
  • Phone: 702-944-2828
  • Fax: 702-944-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number001447
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: