Provider Demographics
NPI:1033103908
Name:RAHIMI, ALI R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:R
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:STE 480
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-562-5765
Mailing Address - Fax:855-327-1927
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 271
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-562-5765
Practice Address - Fax:855-327-1927
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037050207RG0300X
NV15970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF17421Medicare UPIN
GA11BDXGSMedicare ID - Type Unspecified