MEDICARE: DR. TANNAZ NIKRAVESH 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	208100000X	Physical Medicine & Rehabilitation Physician	A88061	CA

General Provider Information

NPI Number	:	1386685774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNAZ NIKRAVESH M.D.

Provider Business Mailing Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE 600
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5501
Country	:	US
Telephone Number	:	310-659-2226
Fax Number	:	323-782-8528

Provider Business Practice Location Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE 600
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5501
Country	:	US
Telephone Number	:	310-659-2226
Fax Number	:	323-782-8528

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/14/2010

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