Healthcare Provider Details

I. General information

NPI: 1598366486
Provider Name (Legal Business Name): NINA SABET-PEYMAN, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 7TH ST
SAN PEDRO CA
90732-3505
US

IV. Provider business mailing address

439 S LAURELTREE DR
ANAHEIM CA
92808-1648
US

V. Phone/Fax

Practice location:
  • Phone: 310-832-3311
  • Fax:
Mailing address:
  • Phone: 480-388-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: NINA SABET-PEYMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 480-388-2795