Provider Demographics
NPI:1780852723
Name:ANSARINIA PROFESSIONAL CORPORTATION
Entity Type:Organization
Organization Name:ANSARINIA PROFESSIONAL CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-951-2243
Mailing Address - Street 1:2835 S. JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-951-2243
Mailing Address - Fax:702-951-2262
Practice Address - Street 1:2835 S. JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-951-2243
Practice Address - Fax:702-951-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV99572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83189Medicare UPIN
V35656Medicare PIN