Provider Demographics
NPI:1366203697
Name:POUPAK ZIAEI MD LLC
Entity type:Organization
Organization Name:POUPAK ZIAEI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POUPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-616-0091
Mailing Address - Street 1:2641 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4836
Mailing Address - Country:US
Mailing Address - Phone:702-616-0091
Mailing Address - Fax:702-616-2329
Practice Address - Street 1:2641 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4836
Practice Address - Country:US
Practice Address - Phone:702-616-0091
Practice Address - Fax:702-616-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty