Healthcare Provider Details

I. General information

NPI: 1093723371
Provider Name (Legal Business Name): NASSER AZIZ-ZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 W REDONDO BEACH BLVD # 407
GARDENA CA
90247
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD # 407
GARDENA CA
90247
US

V. Phone/Fax

Practice location:
  • Phone: 310-527-5554
  • Fax: 310-527-2382
Mailing address:
  • Phone: 310-527-5554
  • Fax: 310-527-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: