1720354467 NPI number — MATTHEW AARON CHRISTIE DO

Table of content: MATTHEW AARON CHRISTIE DO (NPI 1720354467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720354467 NPI number — MATTHEW AARON CHRISTIE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIE
Provider First Name:
MATTHEW
Provider Middle Name:
AARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1720354467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3014 W CHARLESTON BLVD STE 130
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:
89102-0083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-5127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4029 DEAN MARTIN DR
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:
89103-4138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-848-2256
Provider Business Practice Location Address Fax Number:
702-485-6746
Provider Enumeration Date:
03/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: SL1450 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1720354467 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com