MEDICARE: ANSARINIA PROFESSIONAL CORPORTATION

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	2084N0400X	Neurology Physician	9957	NV

General Provider Information

NPI Number	:	1780852723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANSARINIA PROFESSIONAL CORPORTATION

Provider Business Mailing Address
First Line	:	2835 S. JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-951-2243
Fax Number	:	702-951-2262

Provider Business Practice Location Address
First Line	:	2835 S. JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-951-2243
Fax Number	:	702-951-2262

Authorized Official
Title or Position	:	OWNER
Name	:	MEHDI ANSARINIA
Credential	:	M.D.
Telephone Number	:	702-951-2243

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	04/18/2017

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Directions to “ANSARINIA PROFESSIONAL CORPORTATION ” Practice Location

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