| Avencia Medical Center | |
|
3150 N Tenaya Way Suite 240 Las Vegas NV 89128-0443 | |
| (702) 445-7770 | |
| (702) 445-7772 |
| Full Name | Avencia Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 3150 N Tenaya Way, Las Vegas, Nevada |
| Authorized Official Name and Position | Reza Mojtabavi (OWNER) |
| Authorized Official Contact | 7024457770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avencia Medical Center Po Box 34707 Las Vegas NV 89133-4707 Ph: (702) 445-7770 | Avencia Medical Center 3150 N Tenaya Way Suite 240 Las Vegas NV 89128-0443 Ph: (702) 445-7770 |
| NPI Number | 1952530578 |
|---|---|
| Provider Enumeration Date | 07/02/2009 |
| Last Update Date | 12/22/2016 |
| Medicare PECOS PAC ID | 8921144122 |
|---|---|
| Medicare Enrollment ID | O20091001000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952530578 | NPI | - | NPPES |
| 1952530578 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 13155 (Nevada) | Primary |
| Provider Name | Reza Mojtabavi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225152598 PECOS PAC ID: 0840336046 Enrollment ID: I20091001000169 |
| Provider Name | Ahmad Noman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275657579 PECOS PAC ID: 0648395012 Enrollment ID: I20100909000499 |
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