Organization
MAHENDRA DEFONSEKA, MD, CHTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHENDRA DEFONSEKA M.D. (OWNER)
(702) 565-3037
Entity
Organization
Contact information
Practice address
98 E LAKE MEAD PKWY, SUITE 302, HENDERSON, NV 89015-5540
(702) 565-3037
Mailing address
3022 S DURANGO DR, SUITE 100, LAS VEGAS, NV 89117-4439
(702) 967-2352
(702) 967-2354
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
NV3983
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002002520
—
NV
01
—
NV3383
BCBS
—
Enumeration date
05/16/2006
Last updated
03/05/2014
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