Provider Demographics
NPI:1467615401
Name:RAAFAT MOHAMMADKHANI DO PC
Entity Type:Organization
Organization Name:RAAFAT MOHAMMADKHANI DO PC
Other - Org Name:CENTENNIAL HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-221-9355
Mailing Address - Street 1:6850 N DURANGO DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4595
Mailing Address - Country:US
Mailing Address - Phone:702-221-9355
Mailing Address - Fax:702-221-9301
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:SUITE 308
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:702-221-9355
Practice Address - Fax:702-221-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467615402Medicaid
NVBL122Medicare PIN