MEDICARE: CIVIC CENTER PEDIATRICS

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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275716086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIVIC CENTER PEDIATRICS

Provider Business Mailing Address
First Line	:	2025 CIVIC CENTER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6311
Country	:	US
Telephone Number	:	702-633-7970
Fax Number	:	702-633-5649

Provider Business Practice Location Address
First Line	:	2025 CIVIC CENTER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6311
Country	:	US
Telephone Number	:	702-633-7970
Fax Number	:	702-633-5649

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUCHIKA NAYANI RANASINGHE
Credential	:	M.D
Telephone Number	:	702-633-7970

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	01/10/2020

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Directions to “CIVIC CENTER PEDIATRICS ” Practice Location

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