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General NPI Number Information
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NPI Number | 1982585980
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Entity Type | Organization
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Legal Business Name | MASTANEH NIKRAVESH MD PC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 7901 FROST ST
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City | SAN DIEGO
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State | CA
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Zip | 92123-2701
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Country | US
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Telephone | 619-940-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 600 1ST AVE STE 102-2405
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City | SEATTLE
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State | WA
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Zip | 98104-2210
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Country | US
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Telephone | 619-940-7934
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MASTANEH NIKRAVESH
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Credential | MD
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Telephone | 619-869-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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