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General NPI Number Information
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NPI Number | 1306920194
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Entity Type | Individual
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Provider Name | MOHAMAD DJAVAD NAFICY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 9107 WILSHIRE BLVD SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5531
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Country | US
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Telephone | 310-909-3916
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Fax | 310-246-0099
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Provider Business Mailing Address
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Address Line | PO BOX 5360 SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-5360
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Country | US
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Telephone | 310-909-3916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | C51746
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License Number State | CA
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