Provider Demographics
NPI:1760068365
Name:BAGHDASSARIAN, JIRAIR M (APRN)
Entity Type:Individual
Prefix:
First Name:JIRAIR
Middle Name:M
Last Name:BAGHDASSARIAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401406
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-1406
Mailing Address - Country:US
Mailing Address - Phone:702-380-1964
Mailing Address - Fax:702-852-0946
Practice Address - Street 1:5110 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3406
Practice Address - Country:US
Practice Address - Phone:702-380-1964
Practice Address - Fax:702-852-0946
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner