1972797462 NPI number — ALEXANDER F AKHAVAN MD LTD

Table of content: (NPI 1972797462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972797462 NPI number — ALEXANDER F AKHAVAN MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDER F AKHAVAN 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:
1972797462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3022 S DURANGO DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-256-3637
Provider Business Mailing Address Fax Number:
702-256-3307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3186 S MARYLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-254-5358
Provider Business Practice Location Address Fax Number:
702-256-8510
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AKHAVAN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-894-8869

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11478 , 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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