Provider Demographics
NPI:1063490712
Name:NASSERI, AMIR G (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:G
Last Name:NASSERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ARCADE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0119
Mailing Address - Country:US
Mailing Address - Phone:949-387-3801
Mailing Address - Fax:
Practice Address - Street 1:1155 W CENTRAL AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3165
Practice Address - Country:US
Practice Address - Phone:714-966-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9725207V00000X
CAA68974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS10501OtherPHARMACY/CDS
NV002018860Medicaid
NVCS10501OtherPHARMACY/CDS
NVWQBHV35435Medicare ID - Type Unspecified
NV002018860Medicaid