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General NPI Number Information
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NPI Number | 1134324668
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Entity Type | Organization
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Legal Business Name | CHILDRENS UROLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 6670 S TENAYA WAY STE 180
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City | LAS VEGAS
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State | NV
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Zip | 89113-1964
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Country | US
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Telephone | 702-369-4999
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Fax | 702-369-2993
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Provider Business Mailing Address
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Address Line | 6670 S TENAYA WAY STE 180
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City | LAS VEGAS
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State | NV
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Zip | 89113-1964
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Country | US
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Telephone | 702-369-4999
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Fax | 702-369-2993
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Authorized Official
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Title or Position | PARTNER
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Name | DR. GEORGE GANESAN
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Credential | MD
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Telephone | 702-369-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 6402
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License Number State | NV
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