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General NPI Number Information
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NPI Number | 1639576820
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Entity Type | Organization
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Legal Business Name | SHAHAB MOKHTARE INC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 330 S RAMPART BLVD STE 350
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City | LAS VEGAS
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State | NV
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Zip | 89145-5754
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Country | US
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Telephone | 702-420-7704
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Fax |
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Provider Business Mailing Address
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Address Line | 9811 W CHARLESTON BLVD STE 2-441
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone | 702-420-7704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAHAB MOKHTARE
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Credential | MD
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Telephone | 702-420-7704
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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 | 13663
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License Number State | NV
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