Healthcare Provider Details

I. General information

NPI: 1336114370
Provider Name (Legal Business Name): NOSRAT KHAJAVI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NOSRATULLAH KHAJAVI DO

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-7033
  • Fax: 575-532-7025
Mailing address:
  • Phone: 575-532-7033
  • Fax: 575-532-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6281
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA-96592
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: