Organization
DR AJAY NELLUTLA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJAY K NELLUTLA MD (PRESIDENT)
(702) 649-8009
Entity
Organization
Contact information
Practice address
3201 S MARYLAND PKWY, SUITE #100, LAS VEGAS, NV 89109-2441
(702) 649-8009
(702) 649-8049
Mailing address
FILE # 1304-1801 W.OLYMPIC BLVD, PASADENA, CA 91199-1304
(702) 938-0419
(702) 939-6954
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
10766
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356596134
—
NV
Enumeration date
11/20/2008
Last updated
09/28/2010
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