Provider Demographics
NPI:1528339413
Name:ALIREZA FARABI MD PC
Entity type:Organization
Organization Name:ALIREZA FARABI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-451-6870
Mailing Address - Street 1:2285 SPRUCE GOOSE ST APT A304
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2631
Mailing Address - Country:US
Mailing Address - Phone:702-462-8282
Mailing Address - Fax:702-903-4443
Practice Address - Street 1:701 SHADOW LN STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4133
Practice Address - Country:US
Practice Address - Phone:702-462-8282
Practice Address - Fax:702-903-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13143207RI0200X
207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1528339413Medicaid
NV13143OtherNEVADA LICENSE
NVFF1336937OtherDEA CERTIFICATE