Healthcare Provider Details

I. General information

NPI: 1780852723
Provider Name (Legal Business Name): ANSARINIA PROFESSIONAL CORPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 S. JONES BLVD
LAS VEGAS NV
89146
US

IV. Provider business mailing address

2835 S. JONES BLVD
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-951-2243
  • Fax: 702-951-2262
Mailing address:
  • Phone: 702-951-2243
  • Fax: 702-951-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9957
License Number StateNV

VIII. Authorized Official

Name: MEHDI ANSARINIA
Title or Position: OWNER
Credential: M.D.
Phone: 702-951-2243