Active NPI
Faezeh Izadmanesh, MD
- Family Medicine Physician
- Las Vegas, NV
National Provider Identifier
1487836748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 13589
- Practice address
- 9010 W Cheyenne Ave
Las Vegas, NV 89129-8932 - Phone
- (702) 240-8646
- Fax
- (702) 240-0206
- NPI assigned
- Nov 28, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13589 | NV | Primary |
Addresses
Primary practice location
9010 W Cheyenne Ave
Las Vegas, NV 89129-8932
Mailing address
9010 W Cheyenne Ave
Las Vegas, NV 89129-8932
Phone (702) 240-8646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487836748 | Medicaid | NV |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alfaro LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1487836748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9010 W CHEYENNE AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891298932",
"telephone_number": "702-240-8646",
"fax_number": "702-240-0206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9010 W CHEYENNE AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891298932",
"telephone_number": "702-240-8646",
"fax_number": "702-240-0206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZADMANESH",
"first_name": "FAEZEH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-28",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "13589",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1487836748",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.