1033243076 NPI number — R DOMINIC NARDELL MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033243076 NPI number — R DOMINIC NARDELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R DOMINIC NARDELL MD PC
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:
6
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:
1033243076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 VILLAGE CENTER CIR STE 3-328
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:
89134-6238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-558-2111
Provider Business Mailing Address Fax Number:
702-558-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 N TENAYA WAY STE 370
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:
89128-0485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-558-2111
Provider Business Practice Location Address Fax Number:
702-558-8333
Provider Enumeration Date:
03/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NARDELL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
DOMINIC
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-558-2111

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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