Individual
DR. LAHAV NISSIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0198
(602) 933-2492
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
41679
AZ
2085R0204X
Vascular & Interventional Radiology Physician
78350
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
615187
—
AZ
Enumeration date
06/25/2007
Last updated
02/07/2024
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