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General NPI Number Information
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NPI Number | 1912139890
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Entity Type | Organization
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Legal Business Name | MEDICAL INTERNISTS OF NEVADA LLC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 6850 N DURANGO DR SUITE 210
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City | LAS VEGAS
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State | NV
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Zip | 89149-4595
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Country | US
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Telephone | 949-842-7059
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 36830
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City | LAS VEGAS
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State | NV
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Zip | 89133-6830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HOMAYON IRANINEZHAD
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Credential | D.O
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Telephone | 949-842-7059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO1453
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License Number State | NV
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