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NPI Code Detail

MEDICARE: MISS ATOUSA GHANEIAN M.D.

MEDICARE: MISS ATOUSA GHANEIAN 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
1208000000XPediatrics Physician13821NV

General Provider Information

NPI Number : 1104050996
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ATOUSA GHANEIAN M.D.
Provider Business Mailing Address
First Line : 3196 S MARYLAND PKWY STE 411
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2318
Country : US
Telephone Number : 702-444-7685
Fax Number : 702-444-7916
Provider Business Practice Location Address
First Line : 3196 S MARYLAND PKWY STE 411
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2318
Country : US
Telephone Number : 702-444-7685
Fax Number : 702-444-7916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2009
Last Update Date : 04/18/2024

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Directions to “ MISS ATOUSA GHANEIAN M.D.” Practice Location

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