NPIMap

Organization Active NPI

Centennial Dermatology and Skin Cancer Inc

  • Dermatology Physician
  • Las Vegas, NV
National Provider Identifier
1902160252
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CENTENNIAL DERMATOLOGY AND SKIN CANCER INC
Practice address
5550 Painted Mirage Rd
Suite 110
Las Vegas, NV 89149-4581
Phone
(702) 432-3800
NPI assigned
Jul 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Taheri, MDNPI 1992774681
Title
President
Phone
(702) 432-3800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5550 Painted Mirage Rd
Suite 110
Las Vegas, NV 89149-4581

Mailing address

PO Box 496084
Redding, CA 96049-6084
Phone (702) 432-3800

National Provider Directory

National Provider Directory

Locations

5550 Painted Mirage Rd
#110
Las Vegas, NV 89149
Phone (702) 432-3800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1902160252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 496084",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960496084",
            "telephone_number": "702-432-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5550 PAINTED MIRAGE RD",
            "address_2": "SUITE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891494581",
            "telephone_number": "702-432-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL DERMATOLOGY AND SKIN CANCER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "TAHERI",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-432-3800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.