1831330885 NPI number — POUPAK ZIAEI MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831330885 NPI number — POUPAK ZIAEI MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POUPAK ZIAEI MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831330885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5052 S JONES BLVD
Provider Second Line Business Mailing Address:
SUITE 135
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89118-0538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-902-2400
Provider Business Mailing Address Fax Number:
702-902-2401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5052 S JONES BLVD
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89118-0538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-902-2400
Provider Business Practice Location Address Fax Number:
702-902-2401
Provider Enumeration Date:
03/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LABRECQUE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ACCTS. MGR
Authorized Official Telephone Number:
702-453-3799

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  12525 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)