Provider Demographics
NPI:1477731644
Name:NAZERI, KAVOOS CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:KAVOOS
Middle Name:CAMERON
Last Name:NAZERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEYEDKAVOOS
Other - Middle Name:
Other - Last Name:NAZERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:9170 HAVEN AVE STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5416
Practice Address - Country:US
Practice Address - Phone:909-466-0550
Practice Address - Fax:909-466-0755
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110017207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA164176OtherMEDICARE PIN
CAGB939YMedicare PIN