Provider Demographics
NPI:1053065474
Name:N. NICOLE MOAYERI, MD INC
Entity Type:Organization
Organization Name:N. NICOLE MOAYERI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MOAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-770-9186
Mailing Address - Street 1:2410 FLETCHER AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4876
Mailing Address - Country:US
Mailing Address - Phone:805-682-1912
Mailing Address - Fax:
Practice Address - Street 1:2410 FLETCHER AVE FL 3
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4876
Practice Address - Country:US
Practice Address - Phone:805-770-9186
Practice Address - Fax:805-261-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697610Medicaid
CAG27180OtherMEDICARE UPIN