Healthcare Provider Details

I. General information

NPI: 1043490170
Provider Name (Legal Business Name): SYED PERVAIZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W HORIZON RIDGE PKWY SUITE 103
HENDERSON NV
89052-2869
US

IV. Provider business mailing address

4161 S. EASTERN AVE SUITE B3
LAS VEGAS NV
89119
US

V. Phone/Fax

Practice location:
  • Phone: 702-693-6222
  • Fax: 702-492-6816
Mailing address:
  • Phone: 702-693-6222
  • Fax: 702-492-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11875
License Number StateNV

VIII. Authorized Official

Name: DR. SYED PERVAIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 702-498-7706