Healthcare Provider Details

I. General information

NPI: 1114943933
Provider Name (Legal Business Name): REZA NAZEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S BEVERLY DR STE 240
BEVERLY HILLS CA
90212-4818
US

IV. Provider business mailing address

PO BOX 17460
BEVERLY HILLS CA
90209-3460
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-0228
  • Fax:
Mailing address:
  • Phone: 310-652-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA81680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: