Healthcare Provider Details

I. General information

NPI: 1194024968
Provider Name (Legal Business Name): RAMEZ S NASSRI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 LANKERSHIM BLVD STE 617
NORTH HOLLYWOOD CA
91602-1856
US

IV. Provider business mailing address

2537 MOMENTUM PL
CHICAGO IL
60689-5325
US

V. Phone/Fax

Practice location:
  • Phone: 888-447-2362
  • Fax: 888-766-3999
Mailing address:
  • Phone: 616-988-8227
  • Fax: 616-285-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5601006010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: