Provider Demographics
NPI:1366068041
Name:MEDICAL GENETICS OF NEVADA LLC
Entity type:Organization
Organization Name:MEDICAL GENETICS OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-732-6800
Mailing Address - Street 1:2538 ANTHEM VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5551
Mailing Address - Country:US
Mailing Address - Phone:702-732-6800
Mailing Address - Fax:702-932-9611
Practice Address - Street 1:2538 ANTHEM VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5551
Practice Address - Country:US
Practice Address - Phone:702-732-6800
Practice Address - Fax:702-932-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770741555Medicaid