Basic Information
Provider Information
NPI: 1649530858
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAMAZI
FirstName: ALI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 E SILVERADO RANCH BLVD STE 170
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891837518
CountryCode: US
TelephoneNumber: 7022406482
FaxNumber: 7022408529
Practice Location
Address1: 2800 N TENAYA WAY STE 202
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891281100
CountryCode: US
TelephoneNumber: 7022406482
FaxNumber: 7022408529
Other Information
ProviderEnumerationDate: 05/22/2012
LastUpdateDate: 09/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X16357NVY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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