MEDICARE: DR. EJINE OKOROAFOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	15734	NV

General Provider Information

NPI Number	:	1003164377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EJINE OKOROAFOR M.D.

Provider Business Mailing Address
First Line	:	5440 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0355
Country	:	US
Telephone Number	:	914-426-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0355
Country	:	US
Telephone Number	:	914-426-7774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	08/21/2020

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