Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 14717 | NV |
N | 111NI0900X | Internist | 14717 | NV |
N | 207R00000X | Internist | AS3062508-60 | MI |
N | 111NI0900X | Internist | AS3062508-60 | MI |
Y | 207RI0200X | Infectious Disease | 14717 | NV |
NPI | 1023380086 |
---|---|
Provider Name | Dr. Babak Hooshmand |
First Address | Las Vegas, NV 89169-3314 |
Second Address | Las Vegas, NV 89169-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2012 |
Last Update Date | 01/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023380086 | (05) | NV |