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General NPI Number Information
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NPI Number | 1245538479
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Entity Type | Organization
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Legal Business Name | ERAJ BASSERI MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 9033 WILSHIRE BLVD # 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1837
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Country | US
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Telephone | 310-858-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 423 S CRESCENT DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-4505
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Country | US
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Telephone | 310-858-1242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERAJ BASSERI
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Credential | M.D
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Telephone | 310-858-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A91969
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License Number State | CA
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