Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 34611 | AZ |
N | 111NI0900X | Internist | 34611 | AZ |
N | 207R00000X | Internist | A92026 | CA |
N | 111NI0900X | Internist | A92026 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A92026 | CA |
NPI | 1184669160 |
---|---|
Provider Name | Jonathan Nasseri |
First Address | Thousand Oaks, CA 91360-5129 |
Second Address | Thousand Oaks, CA 91360-5129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 15/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005207 | (05) | AZ |
1005053 | (05) | CA |
I49492 | (02) |