Healthcare Provider Details

I. General information

NPI: 1952794000
Provider Name (Legal Business Name): RASHIN GHOLAMREZAEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-952-9171
  • Fax: 702-952-9170
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16476
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: