Healthcare Provider Details

I. General information

NPI: 1770917585
Provider Name (Legal Business Name): NAHID REZAPOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 209
ENCINO CA
91316-5218
US

IV. Provider business mailing address

1125 W 6TH ST
LOS ANGELES CA
90017-1833
US

V. Phone/Fax

Practice location:
  • Phone: 818-205-1200
  • Fax: 818-205-1254
Mailing address:
  • Phone: 213-202-3970
  • Fax: 213-241-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: