MEDICARE: ZAHI NASSOURA MD

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	174400000X	Specialist	A62315	CA

General Provider Information

NPI Number	:	1417995622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAHI NASSOURA MD

Provider Business Mailing Address
First Line	:	18226 VENTURA BOULEVARD
Second Line	:	SUITE 102
City	:	TARZANA
State	:	CA
Zip	:	91356-4246
Country	:	US
Telephone Number	:	818-345-6126
Fax Number	:	818-345-5061

Provider Business Practice Location Address
First Line	:	18226 VENTURA BOULEVARD
Second Line	:	SUITE 102
City	:	TARZANA
State	:	CA
Zip	:	91356-4246
Country	:	US
Telephone Number	:	818-345-6126
Fax Number	:	818-345-5061

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/17/2012

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