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General NPI Number Information
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NPI Number | 1356596134
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Entity Type | Organization
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Legal Business Name | DR AJAY NELLUTLA INC
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 3201 S MARYLAND PKWY SUITE #100
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City | LAS VEGAS
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State | NV
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Zip | 89109-2441
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Country | US
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Telephone | 702-649-8009
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Fax | 702-649-8049
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Provider Business Mailing Address
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Address Line | FILE # 1304-1801 W.OLYMPIC BLVD
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City | PASADENA
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State | CA
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Zip | 91199-1304
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Country | US
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Telephone | 702-938-0419
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Fax | 702-939-6954
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Authorized Official
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Title or Position | PRESIDENT
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Name | AJAY K NELLUTLA
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Credential | MD
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Telephone | 702-649-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 10766
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License Number State | NV
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