Provider Demographics
NPI:1720269517
Name:AREZO MARIA FATHIE M D INC
Entity Type:Organization
Organization Name:AREZO MARIA FATHIE M D INC
Other - Org Name:GENERATIONS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AREZO
Authorized Official - Middle Name:M
Authorized Official - Last Name:FATHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-407-9994
Mailing Address - Street 1:5135 S. DURANGO DR
Mailing Address - Street 2:#102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:702-407-9994
Mailing Address - Fax:702-407-9998
Practice Address - Street 1:5135 S. DURANGO DR.
Practice Address - Street 2:#102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-407-9994
Practice Address - Fax:702-407-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019177Medicaid
NVG97284Medicare UPIN
NVV34815Medicare PIN