Basic Information
Provider Information
NPI: 1699735282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAJIDI
FirstName: FARZAD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 SHADOW LN
Address2: SUITE 240
City: LAS VEGAS
State: NV
PostalCode: 89106
CountryCode: US
TelephoneNumber: 7023840022
FaxNumber: 7023840529
Practice Location
Address1: 700 SHADOW LN
Address2: SUITE 240
City: LAS VEGAS
State: NV
PostalCode: 89106
CountryCode: US
TelephoneNumber: 7023840022
FaxNumber: 7023840529
Other Information
ProviderEnumerationDate: 03/27/2006
LastUpdateDate: 05/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0058795MDN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0000XMD.203531LAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011X15506NVY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
210532905LA MEDICAID
0480870205MS MEDICAID


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