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General NPI Number Information
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NPI Number | 1720346828
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Entity Type | Organization
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Legal Business Name | JACOB MANJOORAN, MD, P.C.
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 3680 E SUNSET RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89120-7219
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Country | US
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Telephone | 702-855-0748
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Fax | 702-486-4531
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Provider Business Mailing Address
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Address Line | 2679 BOTHWELL PL
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City | HENDERSON
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State | NV
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Zip | 89044-4400
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Country | US
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Telephone | 702-480-7825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB MANJOORAN
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Credential | MD
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Telephone | 702-480-7825
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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 | 11276
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License Number State | NV
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