Healthcare Provider Details

I. General information

NPI: 1134369408
Provider Name (Legal Business Name): F KULIYEV PLLC LTD FUAD KULIYEV SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SPRING RIDGE DR
SUSANVILLE CA
96130-6100
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD SUITE 2-231
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 530-252-2000
  • Fax:
Mailing address:
  • Phone: 702-327-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9498
License Number StateNV

VIII. Authorized Official

Name: DR. FUAD KULIYEV
Title or Position: PHYSICIAN
Credential: MD
Phone: 702-453-3799