=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578849998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GICARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2011
-----------------------------------------------------
Last Update Date | 10/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7437 S EASTERN AVE # 4
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-256-3637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7437 S EASTERN AVE # 4
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | SNEHAL ROHIT DESAI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-256-3637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 10807
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------