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NPI Code Detail

MEDICARE: DR. CYRUS NASSERIAN M.D.

MEDICARE: DR. CYRUS NASSERIAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA122271CA

General Provider Information

NPI Number : 1154692556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYRUS NASSERIAN M.D.
Provider Business Mailing Address
First Line : PO BOX 1770
Second Line :
City : LA MESA
State : CA
Zip : 91944-1770
Country : US
Telephone Number : 619-464-1165
Fax Number : 619-567-1011
Provider Business Practice Location Address
First Line : 1161 E COVINA BLVD
Second Line :
City : COVINA
State : CA
Zip : 91724-1523
Country : US
Telephone Number : 909-279-1740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2012
Last Update Date : 02/26/2025

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