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General NPI Number Information
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NPI Number | 1275716086
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Entity Type | Organization
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Legal Business Name | CIVIC CENTER PEDIATRICS
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 2025 CIVIC CENTER DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-6311
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Country | US
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Telephone | 702-633-7970
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Fax | 702-633-5649
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Provider Business Mailing Address
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Address Line | 2025 CIVIC CENTER DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-6311
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Country | US
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Telephone | 702-633-7970
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Fax | 702-633-5649
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUCHIKA NAYANI RANASINGHE
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Credential | M.D
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Telephone | 702-633-7970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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