Healthcare Provider Details

I. General information

NPI: 1699218545
Provider Name (Legal Business Name): NASSIRYMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2016
Last Update Date: 11/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 1429
ORANGE CA
92856-0429
US

V. Phone/Fax

Practice location:
  • Phone: 323-451-2825
  • Fax:
Mailing address:
  • Phone: 323-451-2825
  • Fax: 657-223-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA125091
License Number StateCA

VIII. Authorized Official

Name: AKBAR NASSIRY
Title or Position: PRESIDENT/CEO
Credential: MD, MPH
Phone: 703-994-1639