Provider Demographics
NPI:1992351316
Name:IRIYE MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:IRIYE MEDICAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDUJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-3200
Mailing Address - Street 1:2011 PINTO LANE
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:9780 S. MCCARRAN BLVD
Practice Address - Street 2:#1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-704-5000
Practice Address - Fax:775-404-0000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRIYE MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty