Healthcare Provider Details

I. General information

NPI: 1962794701
Provider Name (Legal Business Name): POUNEH NASSERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

5246 E THE TOLEDO
LONG BEACH CA
90803-1874
US

V. Phone/Fax

Practice location:
  • Phone: 877-824-3627
  • Fax:
Mailing address:
  • Phone: 818-282-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA125520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: