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General NPI Number Information
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NPI Number | 1336437904
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Entity Type | Organization
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Legal Business Name | REZA NABAVIAN, MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD 1180W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2102
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Country | US
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Telephone | 310-829-5550
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Fax | 310-829-5502
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Provider Business Mailing Address
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Address Line | 2001 SANTA MONICA BLVD 1180W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2102
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Country | US
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Telephone | 310-829-5550
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Fax | 310-829-5502
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Authorized Official
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Title or Position | FINANCIAL ADMINISTRATOR
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Name | SHERYL SANTOS
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Credential |
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Telephone | 310-829-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A062706
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License Number State | CA
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