Organization · NPI-2

A Nicknam PC

Family Medicine · Las Vegas, NV

NPI number1659501302
StatusActive
Last updated in NPPESDec 31, 2013

Details

NPI
1659501302
Entity type
Organization (NPI-2)
Legal business name
A Nicknam PC
Organization subpart
No
Enumeration date
Jul 15, 2009
Last updated
Dec 31, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine11368NVYes

Practice location

1712 Bearden Dr
Las Vegas, NV 89106-4107

Phone 702-733-6622 · Fax 702-382-6622

Mailing address

Po Box 34717
Las Vegas, NV 89133-4717

Phone 702-733-6622 · Fax 702-382-6622

Authorized official

Amir K Nicknam
President
7027336622

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