=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164872024
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL RAJIV HANDA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2016
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 S DURANGO DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89113-0137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-240-6482
-----------------------------------------------------
Fax | 702-240-8529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 S RANCHO DR STE E6
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-3812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 22-406-4827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 2023019452
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 26404
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------