Healthcare Provider Details

I. General information

NPI: 1487841821
Provider Name (Legal Business Name): NASIR TEJANI M.D.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 PALO VERDE AVENUE SUITE 203
LONG BEACH CA
90808-4132
US

IV. Provider business mailing address

711 PEPPERTREE LANE
LONG BEACH CA
90815-4731
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-8283
  • Fax: 562-420-9092
Mailing address:
  • Phone: 562-421-8283
  • Fax: 562-420-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA32473
License Number StateCA

VIII. Authorized Official

Name: DR. NASIR TEJANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-421-8283