Healthcare Provider Details

I. General information

NPI: 1407575442
Provider Name (Legal Business Name): NASRI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 340
LAS VEGAS NV
89128-0447
US

IV. Provider business mailing address

5130 S FORT APACHE RD STE 215 PMB 389
LAS VEGAS NV
89148-1732
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-4729
  • Fax: 702-804-4737
Mailing address:
  • Phone: 702-804-4729
  • Fax: 702-804-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SINA NASRI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 28-044-7297