1649729161 NPI number — HOMAYON IRANINEZHAD DO PC

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 1649729161 NPI number — HOMAYON IRANINEZHAD DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMAYON IRANINEZHAD DO PC
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:
1649729161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371086
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89137-1086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-623-6454
Provider Business Mailing Address Fax Number:
702-666-0374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N BUFFALO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89145-0373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-623-3454
Provider Business Practice Location Address Fax Number:
702-666-0374
Provider Enumeration Date:
09/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
AQUINO
Authorized Official First Name:
XENETEIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
702-818-9397

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  DO1453 , 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)





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