MEDICARE: DR. AMIR G NASSERI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	9725	NV
2	207V00000X	Obstetrics & Gynecology Physician	A68974	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS10501	OTHER	NV	PHARMACY/CDS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063490712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR G NASSERI M.D.

Provider Business Mailing Address
First Line	:	25 ARCADE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-0119
Country	:	US
Telephone Number	:	949-387-3801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 W CENTRAL AVE
Second Line	:	SUITE 214
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3165
Country	:	US
Telephone Number	:	714-966-9094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	12/22/2023

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