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General NPI Number Information
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NPI Number | 1013016674
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Entity Type | Individual
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Provider Name | MEHRAN SOUDBAKHSH D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4325 N RANCHO DR #150
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City | LAS VEGAS
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State | NV
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Zip | 89130-3438
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Country | US
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Telephone | 702-658-1681
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Fax | 702-737-6390
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Provider Business Mailing Address
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Address Line | 7509 FENCEROW ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-4546
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Country | US
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Telephone | 702-658-1681
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Fax | 702-737-6390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B716
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License Number State | NV
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