Healthcare Provider Details

I. General information

NPI: 1043642614
Provider Name (Legal Business Name): RAMIN RAY VAEZI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E SAHARA AVE #15
LAS VEGAS NV
89104-3496
US

IV. Provider business mailing address

1380 E SAHARA AVE SUITE A
LAS VEGAS NV
89104-3496
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-0000
  • Fax:
Mailing address:
  • Phone: 702-656-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB02012
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: