1972499572 NPI number — STEPPING STONES PEDIATRICS LLC

Table of content: (NPI 1972499572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972499572 NPI number — STEPPING STONES PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPPING STONES PEDIATRICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972499572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12355 SUNSET SAGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89138-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-237-7563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12355 SUNSET SAGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89138-4719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-237-7563
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MOHOTTIGE-SEDERE
Authorized Official First Name:
ARUNA
Authorized Official Middle Name:
U
Authorized Official Title or Position:
OWNER, C.E.O., CLINICAL DIRECTOR
Authorized Official Telephone Number:
702-237-7563

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972499572 . This is a "CIGNA (EVERNORTH)" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1972499572 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1972499572 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972499572 . This is a "ANTHEM BCBS NEVADA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1972499572 . This is a "AETNA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1972499572 . This is a "NEVADA HEALTH CO-OP, HPN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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