MEDICARE: NOURIEL NIAMEHR DO

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	253051	NY
2	208VP0014X	Interventional Pain Medicine Physician	20A11311	CA
3	208100000X	Physical Medicine & Rehabilitation Physician	20A11311	CA

General Provider Information

NPI Number	:	1679881346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOURIEL NIAMEHR DO

Provider Business Mailing Address
First Line	:	17631 VENTURA BLVD # 363
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3842
Country	:	US
Telephone Number	:	424-262-6260
Fax Number	:	323-916-6363

Provider Business Practice Location Address
First Line	:	18040 SHERMAN WAY STE 200
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4656
Country	:	US
Telephone Number	:	818-212-2223
Fax Number	:	818-212-2224

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

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	07/16/2025

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