| Infectious Disease Partners Of Southern Nevada | |
|
3483 S Eastern Ave Las Vegas NV 89169-3314 | |
| (702) 309-2311 | |
| (702) 309-2177 |
| Full Name | Infectious Disease Partners Of Southern Nevada |
|---|---|
| Speciality | Internal Medicine |
| Location | 3483 S Eastern Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Ronald A Shockley (OWNER) |
| Authorized Official Contact | 7023092311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Partners Of Southern Nevada 3121 S Maryland Pkwy Ste 412 Las Vegas NV 89109 Ph: (702) 309-2311 | Infectious Disease Partners Of Southern Nevada 3483 S Eastern Ave Las Vegas NV 89169-3314 Ph: (702) 309-2311 |
| NPI Number | 1861539652 |
|---|---|
| Provider Enumeration Date | 01/31/2007 |
| Last Update Date | 02/04/2020 |
| Medicare PECOS PAC ID | 7810094976 |
|---|---|
| Medicare Enrollment ID | O20070524000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861539652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Ronald A Shockley |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1275511263 PECOS PAC ID: 4183638414 Enrollment ID: I20060126000010 |
| Provider Name | Babak Hooshmand |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023380086 PECOS PAC ID: 3476787458 Enrollment ID: I20131007000000 |
| Provider Name | Enzi O Abebe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497102214 PECOS PAC ID: 2062797962 Enrollment ID: I20170315001989 |
| Provider Name | Zonia D Fiesta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205390499 PECOS PAC ID: 4486992526 Enrollment ID: I20190214001613 |
| Provider Name | Genus Camilo Sarabia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720647944 PECOS PAC ID: 6507287836 Enrollment ID: I20200522000462 |
| Provider Name | Reza Vaghefi Hosseini |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1184868093 PECOS PAC ID: 0840441200 Enrollment ID: I20200609000988 |
| Provider Name | Aya Werra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093340770 PECOS PAC ID: 7416370788 Enrollment ID: I20200702001771 |
| Provider Name | Hiromichi S Park |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1700313053 PECOS PAC ID: 2860760675 Enrollment ID: I20230103001364 |
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