Healthcare Provider Details

I. General information

NPI: 1699735282
Provider Name (Legal Business Name): FARZAD MAJIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN SUITE 240
LAS VEGAS NV
89106
US

IV. Provider business mailing address

700 SHADOW LN SUITE 240
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-0022
  • Fax: 702-384-0529
Mailing address:
  • Phone: 702-384-0022
  • Fax: 702-384-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0058795
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.203531
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number15506
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: