Provider Demographics
NPI:1730894106
Name:MAHMOUDI, KASRA
Entity type:Individual
Prefix:
First Name:KASRA
Middle Name:
Last Name:MAHMOUDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5967 ROSANNA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0267
Mailing Address - Country:US
Mailing Address - Phone:330-396-9428
Mailing Address - Fax:
Practice Address - Street 1:5967 ROSANNA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0267
Practice Address - Country:US
Practice Address - Phone:330-396-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No372600000XNursing Service Related ProvidersAdult Companion