Provider Demographics
NPI:1124417092
Name:NIRR INC
Entity Type:Organization
Organization Name:NIRR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADOSLAV
Authorized Official - Middle Name:IVOV
Authorized Official - Last Name:RAYCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-290-8683
Mailing Address - Street 1:530 S HEWITT ST UNIT 333
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1913
Mailing Address - Country:US
Mailing Address - Phone:949-448-0302
Mailing Address - Fax:949-448-0335
Practice Address - Street 1:2151 N HARBOR BLVD STE 3100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3825
Practice Address - Country:US
Practice Address - Phone:949-448-0302
Practice Address - Fax:949-448-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X, 2084V0102X
CAA1079595261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty