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General NPI Number Information
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NPI Number | 1831211978
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Entity Type | Individual
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Provider Name | NASSER H MIZBAN M.D
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1904 BAILEY ST STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90033-1700
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Country | US
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Telephone | 323-222-9675
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Fax | 323-343-1314
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Provider Business Mailing Address
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Address Line | 1904 BAILEY ST STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90033-1700
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Country | US
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Telephone | 323-222-9675
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Fax | 323-343-1314
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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 | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | A40153
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License Number State | CA
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