Healthcare Provider Details

I. General information

NPI: 1588633143
Provider Name (Legal Business Name): ABDOLLAH ASSAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N LAKE ST
RENO NV
89501-1020
US

IV. Provider business mailing address

628 N LAKE ST
RENO NV
89501-1020
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-1717
  • Fax: 775-329-2067
Mailing address:
  • Phone: 775-329-1717
  • Fax: 775-329-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number10883
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: