MEDICARE: MUNTASSER THAER AZZA

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	225400000X	Rehabilitation Practitioner		NV

General Provider Information

NPI Number	:	1902751027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUNTASSER THAER AZZA

Provider Business Mailing Address
First Line	:	PO BOX 20692
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89112-2692
Country	:	US
Telephone Number	:	806-881-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 S DECATUR BLVD STE 201A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5239
Country	:	US
Telephone Number	:	702-486-4159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ MUNTASSER THAER AZZA ” Practice Location

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