Provider Demographics
NPI:1578696829
Name:MARY MINA FARID, PC
Entity Type:Organization
Organization Name:MARY MINA FARID, PC
Other - Org Name:FARID L FARID, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:LAMEY
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-914-6050
Mailing Address - Street 1:880 SEVEN HILLS DR
Mailing Address - Street 2:SUITE # 160
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4371
Mailing Address - Country:US
Mailing Address - Phone:702-914-6050
Mailing Address - Fax:702-914-6115
Practice Address - Street 1:880 SEVEN HILLS DR
Practice Address - Street 2:SUITE # 160
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4371
Practice Address - Country:US
Practice Address - Phone:702-914-6050
Practice Address - Fax:702-914-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V38046Medicare ID - Type Unspecified