Healthcare Provider Details

I. General information

NPI: 1114008067
Provider Name (Legal Business Name): NASIR TEJANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 PEPPER TREE LN
LONG BEACH CA
90815-4731
US

IV. Provider business mailing address

711 PEPPERTREE LANE
LONG BEACH CA
90815
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 Code208M00000X
TaxonomyHospitalist Physician
License NumberA32473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA32473
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA32473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: