Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4305 | NV |
Y | 213EG0000X | General Practice | 4305 | NV |
NPI | 1003846544 |
---|---|
Provider Name | Massoud Maxwell Hejazi |
First Address | Las Vegas, NV 89118 |
Second Address | Las Vegas, NV 89118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 11/07/2008 |