Basic Information
| Provider Information | |||||||||
| NPI: | 1528339413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALIREZA FARABI MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 370141 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891370141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832691 | ||||||||
| FaxNumber: | 9498635129 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 SHADOW LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832691 | ||||||||
| FaxNumber: | 9498635129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | FARABI | ||||||||
| AuthorizedOfficialFirstName: | ALIREZA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7022798614 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 13143 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | CS18077 | 01 | NV | PHARMACY LICENSE | OTHER | 13143 | 01 | NV | MEDICAL LICENSE | OTHER | FF1336937 | 01 | NV | DEA CERTIFICATE | OTHER |