Healthcare Provider Details

I. General information

NPI: 1841174612
Provider Name (Legal Business Name): BRIAN OJEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-2484
US

IV. Provider business mailing address

4344 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-2484
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-6314
  • Fax: 702-476-9697
Mailing address:
  • Phone: 702-675-6314
  • Fax: 702-476-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: