MEDICARE: NASRI PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician

General Provider Information

NPI Number	:	1407575442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASRI PLLC

Provider Business Mailing Address
First Line	:	5130 S FORT APACHE RD STE 215
Second Line	:	PMB 389
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1732
Country	:	US
Telephone Number	:	702-804-4729
Fax Number	:	702-804-4737

Provider Business Practice Location Address
First Line	:	3150 N TENAYA WAY STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0447
Country	:	US
Telephone Number	:	702-804-4729
Fax Number	:	702-804-4737

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SINA NASRI
Credential	:	MD
Telephone Number	:	28-044-7297

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	11/08/2022

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