Healthcare Provider Details

I. General information

NPI: 1437183613
Provider Name (Legal Business Name): NASSER HOSSEINI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027
US

IV. Provider business mailing address

PO BOX 81349
PHOENIX AZ
85069-1349
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-1225
  • Fax: 623-931-0088
Mailing address:
  • Phone: 623-931-1225
  • Fax: 623-931-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26976
License Number StateAZ

VIII. Authorized Official

Name: DR. NASSER HOSSEINI
Title or Position: DOCTOR
Credential: M.D.
Phone: 480-596-8525