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General NPI Number Information
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NPI Number | 1477089746
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Entity Type | Organization
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Legal Business Name | HOSPITALITY GROUP
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 3175 SAINT ROSE PKWY SUITE 230
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City | HENDERSON
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State | NV
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Zip | 89052-3506
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Country | US
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Telephone | 702-602-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 3175 SAINT ROSE PKWY SUITE 230
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City | HENDERSON
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State | NV
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Zip | 89052-3506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANUKYA DASARI
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Credential | MD
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Telephone | 702-800-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 16426
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License Number State | NV
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