Healthcare Provider Details

I. General information

NPI: 1275716086
Provider Name (Legal Business Name): CIVIC CENTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 CIVIC CENTER DR
NORTH LAS VEGAS NV
89030-6311
US

IV. Provider business mailing address

2025 CIVIC CENTER DR
NORTH LAS VEGAS NV
89030-6311
US

V. Phone/Fax

Practice location:
  • Phone: 702-633-7970
  • Fax: 702-633-5649
Mailing address:
  • Phone: 702-633-7970
  • Fax: 702-633-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUCHIKA NAYANI RANASINGHE
Title or Position: PRESIDENT
Credential: M.D
Phone: 702-633-7970