MEDICARE: DR. POUYA MOHAJER M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	10841	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V102640	OTHER	NV	MEDICARE UPIN
4	V57425	OTHER	NV	MEDICARE UPIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225030919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POUYA MOHAJER M.D.

Provider Business Mailing Address
First Line	:	5130 S FORT APACHE RD
Second Line	:	STE 215-232
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1719
Country	:	US
Telephone Number	:	702-798-0111
Fax Number	:	844-247-3481

Provider Business Practice Location Address
First Line	:	5741 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5622
Country	:	US
Telephone Number	:	702-798-0111
Fax Number	:	866-333-0436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/02/2021

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Directions to “ DR. POUYA MOHAJER M.D.” Practice Location

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