Healthcare Provider Details

I. General information

NPI: 1538146840
Provider Name (Legal Business Name): SAMIR AK NAZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W EMPIRE AVE
BURBANK CA
91504-3318
US

IV. Provider business mailing address

2307 W EMPIRE AVE
BURBANK CA
91504-3318
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-3420
  • Fax: 818-841-5171
Mailing address:
  • Phone: 818-841-3420
  • Fax: 818-841-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA38614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: