Provider Demographics
NPI:1073523221
Name:VA
Entity Type:Organization
Organization Name:VA
Other - Org Name:VA SOUTHERN NEVADA HEALTH CARE SYSTEM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHIATIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:MOJTABA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOTLAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7026-363-0000
Mailing Address - Street 1:2131 AMERICAS CUP CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1925
Mailing Address - Country:US
Mailing Address - Phone:702-324-5084
Mailing Address - Fax:
Practice Address - Street 1:916 W. OWENS AVE. LAS VEGAS NV 89036
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5494261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health