Provider Demographics
NPI:1184185951
Name:TABRIZI, NASSIM (DPM)
Entity Type:Individual
Prefix:
First Name:NASSIM
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21A HIGH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3423
Mailing Address - Country:US
Mailing Address - Phone:408-876-8011
Mailing Address - Fax:
Practice Address - Street 1:45 RESNIK RD STE 107
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4843
Practice Address - Country:US
Practice Address - Phone:508-747-3567
Practice Address - Fax:508-830-1224
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2528213ES0103X, 213E00000X, 213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty