Reza Mojtabavi, M.D. PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

13155 Issued in NV

Legal business name

REZA MOJTABAVI, M.D. PLLC

Doing business as

Avencia Medical Center

Practice address

3150 N Tenaya Way
Suite 240
Las Vegas, NV 89128-0443

Phone

(702) 445-7770

Fax

(702) 445-7772

NPI assigned

Jul 2, 2009

Last updated

Dec 22, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reza MojtabaviNPI 1225152598

Title

Owner

Phone

(702) 445-7770

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Avencia Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Reza Mojtabavi, MD

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1225152598
  Medicare reassignment Care Compare group NPD Authorized official
• Ahmad Noman, M.D.

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1275657579
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1952530578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34707",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891334707",
            "telephone_number": "702-445-7770",
            "fax_number": "702-445-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "SUITE 240",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-445-7770",
            "fax_number": "702-445-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REZA MOJTABAVI, M.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-02",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "MOJTABAVI",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-445-7770"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "13155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952530578",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avencia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Reynoso
• Tina Reynoso
• Yordanis Reytor Quevedo
• Mario Eduardo Reytor Vega
• Reyzelman Nevada PLLC (Nevada Foot & Ankle)
• Danny Reza
• Juan Reza
• Norma Reza
• Rosa Liliana Reza
• Stephany Michelle Reza

• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.