| Dr Ajay Nellutla Inc | |
|
3201 S Maryland Pkwy Suite #100 Las Vegas NV 89109-2441 | |
| (702) 649-8009 | |
| (702) 649-8049 |
| Full Name | Dr Ajay Nellutla Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3201 S Maryland Pkwy, Las Vegas, Nevada |
| Authorized Official Name and Position | Ajay K Nellutla (PRESIDENT) |
| Authorized Official Contact | 7026498009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Ajay Nellutla Inc File # 1304-1801 W.olympic Blvd Pasadena CA 91199-1304 Ph: (702) 938-0419 | Dr Ajay Nellutla Inc 3201 S Maryland Pkwy Suite #100 Las Vegas NV 89109-2441 Ph: (702) 649-8009 |
| NPI Number | 1356596134 |
|---|---|
| Provider Enumeration Date | 11/20/2008 |
| Last Update Date | 09/28/2010 |
| Medicare PECOS PAC ID | 8729145529 |
|---|---|
| Medicare Enrollment ID | O20090323000420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356596134 | NPI | - | NPPES |
| 1356596134 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 10766 (Nevada) | Primary |
| Provider Name | Ajay K Nellutla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407913718 PECOS PAC ID: 3072504109 Enrollment ID: I20040519000307 |
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