Healthcare Provider Details

I. General information

NPI: 1730523945
Provider Name (Legal Business Name): NASSER HEYRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAGNOLIA AVE STE 115
CORONA CA
92879-3123
US

IV. Provider business mailing address

800 MAGNOLIA AVE STE 115
CORONA CA
92879-3123
US

V. Phone/Fax

Practice location:
  • Phone: 657-235-9355
  • Fax: 951-905-5587
Mailing address:
  • Phone: 657-235-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA133075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: