Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B716 | NV |
NPI | 1013016674 |
---|---|
Provider Name | Dr. Mehran Soudbakhsh |
First Address | Las Vegas, NV 89131-4546 |
Second Address | Las Vegas, NV 89130-3438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3602012 | (05) | NV |
U68520 | (02) | NV |