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Todd A Radivan, PA-C
Medical Physician Assistant in Las Vegas, Nevada
NPI 1497757181

Todd A Radivan is a Medical Physician Assistant based in Las Vegas, NV and is specialized in Medical. Todd A Radivan practices in Las Vegas, NV and has the professional credentials of PA-C. The NPI Number for Todd A Radivan is 1497757181 and holds a License No. PA-C57 (Nevada).

The current practice location address for Todd A Radivan is 888 S Rancho Dr, Las Vegas, NV and can be reached out via phone at 702-877-8600. You can also correspond with Todd A Radivan through the mailing address at PO BOX 15645, LAS VEGAS, NV - 89114-5645 (mailing address contact number: 702-877-8600).

Location: 888 S Rancho Dr, Las Vegas, NV, 89114-5645
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Provider Profile Details
NPI Number
1497757181
Provider Name
Todd A Radivan
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
888 S Rancho Dr, Las Vegas, NV, 89114-5645
Phone Number
702-877-8600
Fax Number
Provider Enumeration Date
08/11/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
V110823 01 NV SMA MEDICARE
1497757181 01 NV SMA MEDICAID
institution
Provider Business Practice Location Address Details
Address
888 S Rancho Dr
City
State
Zip
89106-3810
Phone Number
702-877-8600
Fax Number
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Provider Business Mailing Address Details
Address
Po Box 15645
City
State
Zip
89114-5645
Phone Number
702-877-8600
Fax Number
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Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA-C57 (Nevada)
Definition
Definition to come...

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