MEDICARE: PARISA SATTAKEH NPA-CPT

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	246RM2200X	Medical Laboratory Technician	57927-AL-0	NV
2	246RP1900X	Phlebotomy Technician	57927-AL-0	NV
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477148955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARISA SATTAKEH NPA-CPT

Provider Business Mailing Address
First Line	:	1137 GLISTENING ACRES AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1547
Country	:	US
Telephone Number	:	702-984-0637
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 COVINGTON CROSS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6595
Country	:	US
Telephone Number	:	877-751-5783
Fax Number	:

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

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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