MEDICARE: MRS. NAZANIN MATLOUBI 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	2084N0400X	Neurology Physician	A96114	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790783942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAZANIN MATLOUBI M.D.

Provider Business Mailing Address
First Line	:	1505 N EDGEMONT ST
Second Line	:	5T FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5209
Country	:	US
Telephone Number	:	323-783-7699
Fax Number	:	502-589-0805

Provider Business Practice Location Address
First Line	:	1505 N EDGEMONT ST
Second Line	:	5T FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5209
Country	:	US
Telephone Number	:	323-783-7699
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/01/2021

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