Provider Demographics
NPI:1184669160
Name:NASSERI, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NASSERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROUZBEH
Other - Middle Name:
Other - Last Name:NASSERIZAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1534 N MOORPARK RD
Mailing Address - Street 2:STE 290
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:805-522-2500
Mailing Address - Fax:
Practice Address - Street 1:1534 N MOORPARK RD
Practice Address - Street 2:STE 290
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5129
Practice Address - Country:US
Practice Address - Phone:805-522-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34611207R00000X
CAA92026207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1005053Medicaid
AZ005207Medicaid
CA1005053Medicaid