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NPI Code Detail

MEDICARE: AFSHEEN AGHDASIZAD

MEDICARE:   AFSHEEN  AGHDASIZAD
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
1171W00000XContractor

General Provider Information

NPI Number : 1598047714
Entity Type Code : Individual
Provider Name (Legal Business Name) : AFSHEEN AGHDASIZAD
Provider Business Mailing Address
First Line : 6121 PEACH ORCHARD RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89142-0949
Country : US
Telephone Number : 702-487-5489
Fax Number :
Provider Business Practice Location Address
First Line : 6121 PEACH ORCHARD RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89142-0949
Country : US
Telephone Number : 702-487-5489
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 09/13/2011

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Directions to “ AFSHEEN AGHDASIZAD ” Practice Location

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