MEDICARE: DR. FAEZEH NASSRY 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
1	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	2084P0800X	Psychiatry Physician	A172293	CA

General Provider Information

NPI Number	:	1922462274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAEZEH NASSRY M.D.

Provider Business Mailing Address
First Line	:	675 S ARROYO PKWY STE 420
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 S ARROYO PKWY STE 430
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3972
Country	:	US
Telephone Number	:	424-284-2440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	10/14/2024

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