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General NPI Number Information
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NPI Number | 1588816425
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Entity Type | Individual
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Provider Name | ALIREZA NIKBAKSH TEHRANI D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 19341 BEAR VALLEY RD SUITE 205
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City | APPLE VALLEY
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State | CA
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Zip | 92308-5151
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Country | US
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Telephone | 760-240-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 17868 US HIGHWAY 18 #357
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1267
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Country | US
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Telephone | 760-927-2002
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | OS012696
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 20A10839
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License Number State | CA
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