Healthcare Provider Details

I. General information

NPI: 1265691844
Provider Name (Legal Business Name): SHABNAM DARBARI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 SMOKE RANCH RD SUITE 120
LAS VEGAS NV
89128-8306
US

IV. Provider business mailing address

PO BOX 36830
LAS VEGAS NV
89133-6830
US

V. Phone/Fax

Practice location:
  • Phone: 702-224-2505
  • Fax: 702-562-8680
Mailing address:
  • Phone: 702-224-2505
  • Fax: 702-562-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10032
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number10032
License Number StateNV

VIII. Authorized Official

Name: DR. SHABNAM DARBARI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-985-9699