Healthcare Provider Details

I. General information

NPI: 1619062171
Provider Name (Legal Business Name): MONA ELKOMOS-BOTROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

IV. Provider business mailing address

6900 N PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

V. Phone/Fax

Practice location:
  • Phone: 718-363-6641
  • Fax:
Mailing address:
  • Phone: 702-791-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number200426
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: