Provider Demographics
NPI:1215195557
Name:NAZARI, REZA (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:NAZARI
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 1:777 E HAWKEYE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-7506
Mailing Address - Country:US
Mailing Address - Phone:209-668-8030
Mailing Address - Fax:209-668-8031
Practice Address - Street 1:777 E HAWKEYE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-7506
Practice Address - Country:US
Practice Address - Phone:209-668-8030
Practice Address - Fax:209-668-8031
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97476207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease