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General NPI Number Information
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NPI Number | 1669058400
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Entity Type | Individual
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Provider Name | KOMAL KAUR PORDAL MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 6600 W CHARLESTON BLVD STE 142
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City | LAS VEGAS
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State | NV
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Zip | 89146-1050
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Country | US
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Telephone | 702-440-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 W CHARLESTON BLVD STE 142
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City | LAS VEGAS
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State | NV
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Zip | 89146-1050
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Country | US
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Telephone | 702-440-8430
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 27328
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License Number State | NV
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