Provider Demographics
NPI:1225030919
Name:MOHAJER, POUYA (MD)
Entity Type:Individual
Prefix:DR
First Name:POUYA
Middle Name:
Last Name:MOHAJER
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 1:5130 S FORT APACHE RD
Mailing Address - Street 2:STE 215-232
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1719
Mailing Address - Country:US
Mailing Address - Phone:702-798-0111
Mailing Address - Fax:844-247-3481
Practice Address - Street 1:5741 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5622
Practice Address - Country:US
Practice Address - Phone:702-798-0111
Practice Address - Fax:866-333-0436
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10841207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102640OtherMEDICARE UPIN
NV100503617Medicaid
NV1770556037Medicaid
NVV57425OtherMEDICARE UPIN
40412Medicare ID - Type Unspecified