MEDICARE: PATRICIA MARIA GANJA PA-C

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	363AM0700X	Medical Physician Assistant	PA 1391	NV

General Provider Information

NPI Number	:	1457605289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIA GANJA PA-C

Provider Business Mailing Address
First Line	:	5130 S FORT APACHE RD STE 215-232
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1719
Country	:	US
Telephone Number	:	702-281-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5622
Country	:	US
Telephone Number	:	702-798-0111
Fax Number	:	844-247-3481

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

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	07/03/2019

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