Healthcare Provider Details

I. General information

NPI: 1083624688
Provider Name (Legal Business Name): DESERT CARDIOVASCULAR SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E FLAMINGO RD STE 205
LAS VEGAS NV
89119-5192
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD #2-768
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-7070
  • Fax: 702-450-7072
Mailing address:
  • Phone: 702-450-7070
  • Fax: 702-450-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: HAZEM Y AFIFI
Title or Position: OWNER
Credential: M.D.
Phone: 702-450-7070