Provider Demographics
NPI:1336114370
Name:KHAJAVI, NOSRAT (DO)
Entity Type:Individual
Prefix:DR
First Name:NOSRAT
Middle Name:
Last Name:KHAJAVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:NOSRATULLAH
Other - Middle Name:
Other - Last Name:KHAJAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:205 W BOUTZ RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7033
Mailing Address - Fax:575-532-7025
Practice Address - Street 1:205 W BOUTZ RD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3259
Practice Address - Country:US
Practice Address - Phone:575-532-7033
Practice Address - Fax:575-532-7025
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-96592207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology