Healthcare Provider Details

I. General information

NPI: 1811049158
Provider Name (Legal Business Name): MARIAM ALIM-MARVASTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAM ALIM-MARVASTI MD

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N TENAYA WAY
LAS VEGAS NV
89128-0427
US

IV. Provider business mailing address

8757 CARLITAS JOY CT
LAS VEGAS NV
89117
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-0835
  • Fax:
Mailing address:
  • Phone: 702-278-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number9126
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: