Basic Information
| Provider Information | |||||||||
| NPI: | 1548815616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RD PRABHU-LATA K SHETE MDS LTD | ||||||||
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| OtherOrganizationName: | THE SLEEP CENTER OF NEVADA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 W. CHARLESTON BLVD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028779514 | ||||||||
| FaxNumber: | 7023123510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1905 CIVIC CENTER DRIVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | N. LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026493736 | ||||||||
| FaxNumber: | 7026493709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLOCK | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING AGENT | ||||||||
| AuthorizedOfficialTelephone: | 7023189072 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.