Provider Demographics
NPI:1912139890
Name:MEDICAL INTERNISTS OF NEVADA LLC
Entity type:Organization
Organization Name:MEDICAL INTERNISTS OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOMAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANINEZHAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-842-7059
Mailing Address - Street 1:PO BOX 36830
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:949-842-7059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty