MEDICARE: VA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	5494	NV

General Provider Information

NPI Number	:	1073523221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA

Provider Business Mailing Address
First Line	:	2131 AMERICAS CUP CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1925
Country	:	US
Telephone Number	:	702-324-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 W. OWENS AVE. LAS VEGAS NV 89036
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117
Country	:	US
Telephone Number	:	702-636-3000
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATIST
Name	:	PROF. MOJTABA R MOTLAGH
Credential	:	MD
Telephone Number	:	70263630000

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/14/2008

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Directions to “VA ” Practice Location

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