Healthcare Provider Details

I. General information

NPI: 1649530858
Provider Name (Legal Business Name): ALI NAMAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N TENAYA WAY STE 202
LAS VEGAS NV
89128-1100
US

IV. Provider business mailing address

700 E SILVERADO RANCH BLVD STE 170
LAS VEGAS NV
89183-7518
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-6482
  • Fax: 702-240-8529
Mailing address:
  • Phone: 702-240-6482
  • Fax: 702-240-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16357
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: