Provider Demographics
NPI:1346346129
Name:BITA H NASSERI MD CORP
Entity Type:Organization
Organization Name:BITA H NASSERI MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NASSERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-729-3116
Mailing Address - Street 1:225 S LAKE AVE
Mailing Address - Street 2:535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-396-0851
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:#103
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-278-8200
Practice Address - Fax:310-274-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71012207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM013AMedicare PIN
CAW18240Medicare PIN
H76275Medicare UPIN