Healthcare Provider Details

I. General information

NPI: 1205490802
Provider Name (Legal Business Name): IRADJ NAZARIAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5043 WHITTIER BLVD
LOS ANGELES CA
90022-3116
US

IV. Provider business mailing address

5043 WHITTIER BLVD
LOS ANGELES CA
90022-3116
US

V. Phone/Fax

Practice location:
  • Phone: 323-523-8972
  • Fax: 323-604-3907
Mailing address:
  • Phone: 323-523-8972
  • Fax: 323-604-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: IRADJ NAZARIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 323-526-8972