Healthcare Provider Details

I. General information

NPI: 1851619407
Provider Name (Legal Business Name): NIMA REZAEI ABBASSI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 CENTER AVE SUITE 301
HUNTINGTON BEACH CA
92647-3074
US

IV. Provider business mailing address

1595 E 17TH ST
SANTA ANA CA
92705-8506
US

V. Phone/Fax

Practice location:
  • Phone: 714-901-2007
  • Fax: 714-901-2003
Mailing address:
  • Phone: 714-399-0678
  • Fax: 714-276-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA131669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: