Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 20A9369 | CA |
N | 207RA0401X | Internist - Addiction Medicine | 20A9369 | CA |
NPI | 1831367762 |
---|---|
Provider Name | Dr. Ali Nassiri |
First Address | Riverside, CA 92516-1201 |
Second Address | Glendale, CA 91208-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2008 |
Last Update Date | 21/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1831367762 | (05) | CA |