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4055 Spencer St Ste 106 Las Vegas NV 89119-5250 | |
| (702) 582-8705 | |
| (888) 433-5792 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4055 Spencer St Ste 106, Las Vegas, Nevada |
| Authorized Official Name and Position | Deepa Hasija (OWNER) |
| Authorized Official Contact | 2012863100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4055 Spencer St Ste 106 Las Vegas NV 89119-5250 Ph: (702) 582-8705 | 4055 Spencer St Ste 106 Las Vegas NV 89119-5250 Ph: (702) 582-8705 |
| NPI Number | 1841721917 |
|---|---|
| Provider Enumeration Date | 03/21/2017 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Medicare PECOS PAC ID | 6901183284 |
|---|---|
| Medicare Enrollment ID | O20170516001125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841721917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Deepa Hasija |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801107040 PECOS PAC ID: 9931325347 Enrollment ID: I20161026002015 |
| Provider Name | Genevie Kneir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760922017 PECOS PAC ID: 1951660810 Enrollment ID: I20180123000009 |
| Provider Name | Ebony Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396293841 PECOS PAC ID: 9133417645 Enrollment ID: I20200319002443 |
| Provider Name | Melvin Banzon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952925513 PECOS PAC ID: 6608298559 Enrollment ID: I20200622002706 |
| Provider Name | Joseph Vincent Aufheimer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538892054 PECOS PAC ID: 6103209473 Enrollment ID: I20220818002797 |
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