Healthcare Provider Details

I. General information

NPI: 1235327263
Provider Name (Legal Business Name): NASSER DELAFRAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 105
BEVERLY HILLS CA
90211-2919
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 105
BEVERLY HILLS CA
90211-2919
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-8678
  • Fax: 310-289-1161
Mailing address:
  • Phone: 310-289-8678
  • Fax: 310-289-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA40657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: