Healthcare Provider Details

I. General information

NPI: 1316537632
Provider Name (Legal Business Name): MR. SAMIR BILL NASSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 E SUNSET RD STE 201A
LAS VEGAS NV
89120-3246
US

IV. Provider business mailing address

3663 E SUNSET RD STE 201A
LAS VEGAS NV
89120-3246
US

V. Phone/Fax

Practice location:
  • Phone: 702-881-4033
  • Fax: 702-780-4441
Mailing address:
  • Phone: 702-881-4033
  • Fax: 702-780-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number103TH0100X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: