Healthcare Provider Details

I. General information

NPI: 1306616156
Provider Name (Legal Business Name): BEHNOUSH ABYAZI HOSSEINPOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S EASTERN AVE
LAS VEGAS NV
89119-0810
US

IV. Provider business mailing address

4040 S EASTERN AVE
LAS VEGAS NV
89119-0810
US

V. Phone/Fax

Practice location:
  • Phone: 702-764-6044
  • Fax:
Mailing address:
  • Phone: 702-764-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN90532
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: