Healthcare Provider Details

I. General information

NPI: 1003415654
Provider Name (Legal Business Name): SADEGHI MEDICAL SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6771 W CHARLESTON BLVD STE B
LAS VEGAS NV
89146-9016
US

IV. Provider business mailing address

3622 CALICO COVE CT
LAS VEGAS NV
89147-6801
US

V. Phone/Fax

Practice location:
  • Phone: 973-330-2722
  • Fax: 702-988-5154
Mailing address:
  • Phone: 973-330-2722
  • Fax: 702-988-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICK SADEGHI
Title or Position: OWNER
Credential: MD
Phone: 973-330-2722