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General NPI Number Information
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NPI Number | 1629054994
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Entity Type | Organization
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Legal Business Name | LAS VEGAS UROLOGY LLP
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 7150 W SUNSET RD STE 202B
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City | LAS VEGAS
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State | NV
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Zip | 89113-1981
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Country | US
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Telephone | 702-385-4342
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Fax | 702-385-4346
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Provider Business Mailing Address
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Address Line | 7150 W SUNSET RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89113-1982
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Country | US
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Telephone | 702-385-4342
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Fax | 702-385-4346
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Authorized Official
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Title or Position | MNG MBR
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Name | VICTOR E. GRIGORIEV
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Credential | MD
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Telephone | 702-233-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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