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General NPI Number Information
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NPI Number | 1639171283
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Entity Type | Individual
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Provider Name | EBERHARD JOHANNES MAENDEL PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 630 S RANCHO DR SUITE E
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City | LAS VEGAS
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State | NV
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Zip | 89106-4873
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Country | US
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Telephone | 702-258-1001
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Fax | 702-258-3455
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Provider Business Mailing Address
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Address Line | 2285 CORPORATE CIR STE 200
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City | HENDERSON
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State | NV
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Zip | 89074-7759
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Country | US
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Telephone | 702-360-2763
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Fax | 949-783-2880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 569
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License Number State | NV
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