Healthcare Provider Details

I. General information

NPI: 1205542669
Provider Name (Legal Business Name): NAVA HOSSEINNEZHAD BAHRAMJERDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 JUNIPER ST
LOS ANGELES CA
90002-3166
US

IV. Provider business mailing address

3925 E 3RD ST
LONG BEACH CA
90814-2802
US

V. Phone/Fax

Practice location:
  • Phone: 323-789-5610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95036973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: