Provider Demographics
NPI:1437183613
Name:NASSER HOSSEINI MD PLLC
Entity Type:Organization
Organization Name:NASSER HOSSEINI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-596-8525
Mailing Address - Street 1:PO BOX 81349
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1349
Mailing Address - Country:US
Mailing Address - Phone:623-931-1225
Mailing Address - Fax:623-931-0088
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-931-1225
Practice Address - Fax:623-931-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW5431OtherHEALTHNET
AZ0743300OtherBLUE CROSS BLUE SHIELD
AZ439605Medicaid
AZP00114881OtherRAILROAD MEDICARE
AZ0743300OtherBLUE CROSS BLUE SHIELD
AZ439605Medicaid