Active NPI
Shahram Fazlali
- Home Health Aide
- Henderson, NV
National Provider Identifier
1235745720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 002140367
- Practice address
- 1575 Comfort Hills St
Henderson, NV 89014-7617 - Phone
- (310) 467-6710
- NPI assigned
- Sep 20, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 002140367 | CA | Primary |
Addresses
Primary practice location
1575 Comfort Hills St
Henderson, NV 89014-7617
Mailing address
1575 Comfort Hills St
Henderson, NV 89014-7617
Phone (310) 467-6710
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002140367 | CA | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600560000000",
"number": "1235745720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 COMFORT HILLS ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890147617",
"telephone_number": "310-467-6710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 COMFORT HILLS ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890147617",
"telephone_number": "310-467-6710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZLALI",
"first_name": "SHAHRAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-20",
"last_updated": "2020-09-20",
"certification_date": "2020-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "CA",
"license": "002140367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.