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General NPI Number Information
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NPI Number | 1619590684
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Entity Type | Individual
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Provider Name | NATHAN MICHEL RAZBANNIA MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 4676 ADMIRALTY WAY FL 4
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6601
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Country | US
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Telephone | 424-314-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4351046014
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A187022
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License Number State | CA
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