Healthcare Provider Details

I. General information

NPI: 1982934840
Provider Name (Legal Business Name): N NAZARIAN MD A MED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CARLA LINE
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

1340 CARLA LINE
BEVERLY HILLS CA
90210-2509
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-3099
  • Fax:
Mailing address:
  • Phone: 310-274-3099
  • Fax: 310-275-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA34340
License Number StateCA

VIII. Authorized Official

Name: NAHID NAZARIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-274-3099