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General NPI Number Information
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NPI Number | 1699775684
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Entity Type | Individual
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Provider Name | MAHENDRA DEFONSEKA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2610 W HORIZON RIDGE PKWY SUITE 105
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City | HENDERSON
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State | NV
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Zip | 89052-2869
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Country | US
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Telephone | 702-565-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 W SAHARA AVE SUITE 235
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City | LAS VEGAS
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State | NV
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Zip | 89117-7905
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Country | US
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Telephone | 702-256-3637
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Fax | 702-256-3307
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3983
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License Number State | NV
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