Healthcare Provider Details

I. General information

NPI: 1376799064
Provider Name (Legal Business Name): TABREEZ SHIRAAZ ALI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BROOKRIDGE DR
HENDERSON NV
89052-6620
US

IV. Provider business mailing address

PO BOX 36830
LAS VEGAS NV
89133-6830
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-7055
  • Fax: 702-991-7258
Mailing address:
  • Phone: 702-487-7055
  • Fax: 702-991-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1552
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO1552
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: