Healthcare Provider Details

I. General information

NPI: 1588822936
Provider Name (Legal Business Name): OKEY JUSTIN OPARANAKU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 CAMINO AL NORTE
NORTH LAS VEGAS NV
89031-2373
US

IV. Provider business mailing address

5105 CAMINO AL NORTE
NORTH LAS VEGAS NV
89031-2373
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-2173
  • Fax: 702-750-2173
Mailing address:
  • Phone: 702-750-2173
  • Fax: 702-750-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number44562
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250282
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101244164
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number15157
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: