Provider Demographics
NPI:1831411313
Name:SUNSET CLINIC
Entity type:Organization
Organization Name:SUNSET CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FERDOWSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-589-5135
Mailing Address - Street 1:4830 W LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2239
Mailing Address - Country:US
Mailing Address - Phone:702-645-8555
Mailing Address - Fax:702-645-2828
Practice Address - Street 1:4830 W LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2239
Practice Address - Country:US
Practice Address - Phone:702-645-8555
Practice Address - Fax:702-645-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2012-04-13
Deactivation Date:2011-01-27
Deactivation Code:
Reactivation Date:2012-04-13
Provider Licenses
StateLicense IDTaxonomies
NV1019261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center