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NPI Code Detail

MEDICARE: KHATERE NADERI-ASHOUR AGNP

MEDICARE: KHATERE NADERI-ASHOUR AGNP
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
1363L00000XNurse Practitioner95022144CA

General Provider Information

NPI Number : 1295446078
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHATERE NADERI-ASHOUR AGNP
Provider Business Mailing Address
First Line : 113 WATERWORKS WAY STE 155
Second Line :
City : IRVINE
State : CA
Zip : 92618-3163
Country : US
Telephone Number : 949-612-9090
Fax Number : 949-612-9091
Provider Business Practice Location Address
First Line : 113 WATERWORKS WAY STE 155
Second Line :
City : IRVINE
State : CA
Zip : 92618-3163
Country : US
Telephone Number : 949-612-9090
Fax Number : 949-612-9091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 02/01/2024

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