Basic Information
Provider Information
NPI: 1942922323
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAHEDI
FirstName: PAYAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2860 E FLAMINGO RD STE K
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891215270
CountryCode: US
TelephoneNumber: 7023185005
FaxNumber:  
Practice Location
Address1: 2860 E FLAMINGO RD STE K
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891215270
CountryCode: US
TelephoneNumber: 7023185005
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2022
LastUpdateDate: 09/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372500000X NVN Nursing Service Related ProvidersChore Provider 
372600000X NVN Nursing Service Related ProvidersAdult Companion 
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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