MEDICARE: CAL PSYCHIATRIC SERVICES

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	A84300	CA

General Provider Information

NPI Number	:	1619255122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	3027 E SUNSET RD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2758
Country	:	US
Telephone Number	:	702-629-7490
Fax Number	:	702-629-7685

Provider Business Practice Location Address
First Line	:	3027 E SUNSET RD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2758
Country	:	US
Telephone Number	:	702-629-7490
Fax Number	:	702-629-7685

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AKINDELE EMMANUEL KOLADE
Credential	:	MD
Telephone Number	:	702-629-7490

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	04/03/2025

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