Healthcare Provider Details

I. General information

NPI: 1780350009
Provider Name (Legal Business Name): REZA VAGHEFI PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5014
US

IV. Provider business mailing address

10577 ACACIA PARK PL
LAS VEGAS NV
89135-1243
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-4554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: REZA VAGHEFI HOSSEINI
Title or Position: PROVIDER
Credential: MD
Phone: 702-487-7055