Healthcare Provider Details

I. General information

NPI: 1700338084
Provider Name (Legal Business Name): ANSARINIA NEURO-HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 S JONES BLVD
LAS VEGAS NV
89146-5307
US

IV. Provider business mailing address

2835 S JONES BLVD
LAS VEGAS NV
89146-5307
US

V. Phone/Fax

Practice location:
  • Phone: 702-951-2243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberNV20161411462
License Number StateNV

VIII. Authorized Official

Name: DR. MEHDI ANSARINIA
Title or Position: DIRECTOR
Credential:
Phone: 702-951-2243