Provider Demographics
NPI:1386685774
Name:NIKRAVESH, TANNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:
Last Name:NIKRAVESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5501
Mailing Address - Country:US
Mailing Address - Phone:310-659-2226
Mailing Address - Fax:323-782-8528
Practice Address - Street 1:6404 WILSHIRE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5501
Practice Address - Country:US
Practice Address - Phone:310-659-2226
Practice Address - Fax:323-782-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88061208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation