Provider Demographics
NPI:1033233481
Name:ANSARINIA, MEHDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:ANSARINIA
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 1:8916 DIAMOND FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5700
Mailing Address - Country:US
Mailing Address - Phone:702-581-9572
Mailing Address - Fax:
Practice Address - Street 1:2835 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5307
Practice Address - Country:US
Practice Address - Phone:702-951-2243
Practice Address - Fax:702-951-2262
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018493Medicaid
NV002018493Medicaid