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General NPI Number Information
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NPI Number | 1699030569
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Entity Type | Organization
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Legal Business Name | NIMA YAVARI MD, INC.
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1001 TIVERTON AVE APT #3129
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City | LOS ANGELES
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State | CA
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Zip | 90024-3020
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Country | US
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Telephone | 310-443-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 TIVERTON AVE APT #3129
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City | LOS ANGELES
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State | CA
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Zip | 90024-3020
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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 | PHYSICIAN
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Name | DR. NIMA YAVARI
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Credential | M.D.
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Telephone | 917-755-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A106363
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License Number State | CA
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