1710110838 NPI number — SAMEERA SBAIH MD PROF CORP

Table of content: (NPI 1710110838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710110838 NPI number — SAMEERA SBAIH MD PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMEERA SBAIH MD PROF CORP
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:
1710110838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 531473
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89053-1473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-489-4500
Provider Business Mailing Address Fax Number:
702-489-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2649 WIGWAM PKWY
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-7310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-489-4500
Provider Business Practice Location Address Fax Number:
702-489-4600
Provider Enumeration Date:
08/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SBAIH
Authorized Official First Name:
SAMEERA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-489-4500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  11954 , 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)

  • Identifier: 11954 . This is a "NV MEDICAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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