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General NPI Number Information
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NPI Number | 1407086697
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Entity Type | Organization
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Legal Business Name | S SAFAEI PC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 09/27/2009
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Provider Practice Location Address
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Address Line | 9499 W CHARLESTON BLVD #150
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City | LAS VEGAS
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State | NV
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Zip | 89117-7150
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Country | US
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Telephone | 702-575-7423
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | LOGANDALE
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State | NV
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Zip | 89021
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Country | US
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Telephone | 702-328-2708
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Fax |
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Authorized Official
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Title or Position | CEO / OWNER
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Name | DR. SANA SAFAEI
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Credential | MD
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Telephone | 702-575-7423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11497
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License Number State | NV
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