Healthcare Provider Details

I. General information

NPI: 1225030919
Provider Name (Legal Business Name): POUYA MOHAJER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 S FORT APACHE RD STE 120
LAS VEGAS NV
89148-5622
US

IV. Provider business mailing address

5130 S FORT APACHE RD STE 215-232
LAS VEGAS NV
89148-1719
US

V. Phone/Fax

Practice location:
  • Phone: 702-798-0111
  • Fax: 866-333-0436
Mailing address:
  • Phone: 702-798-0111
  • Fax: 844-247-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number10841
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: