Provider Demographics
NPI:1831330885
Name:POUPAK ZIAEI MD LTD
Entity type:Organization
Organization Name:POUPAK ZIAEI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCTS. MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LABRECQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-453-3799
Mailing Address - Street 1:5052 S JONES BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0538
Mailing Address - Country:US
Mailing Address - Phone:702-902-2400
Mailing Address - Fax:702-902-2401
Practice Address - Street 1:5052 S JONES BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0538
Practice Address - Country:US
Practice Address - Phone:702-902-2400
Practice Address - Fax:702-902-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty