Provider Demographics
NPI:1417486846
Name:ARYAEI, NAZAR MOHAMMAD
Entity Type:Individual
Prefix:MR
First Name:NAZAR
Middle Name:MOHAMMAD
Last Name:ARYAEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 W COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5044
Mailing Address - Country:US
Mailing Address - Phone:925-207-9084
Mailing Address - Fax:
Practice Address - Street 1:290 HAVENWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:925-383-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB9261875344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA98571333D75073Medicaid