Provider Demographics
NPI:1528374170
Name:DORSA NASSERI MARYSKA M.D., INC.
Entity Type:Organization
Organization Name:DORSA NASSERI MARYSKA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DORSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-562-9062
Mailing Address - Street 1:101 E BEVERLY BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4316
Mailing Address - Country:US
Mailing Address - Phone:323-722-7418
Mailing Address - Fax:323-722-7894
Practice Address - Street 1:101 E BEVERLY BLVD STE 304
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4316
Practice Address - Country:US
Practice Address - Phone:323-722-7418
Practice Address - Fax:323-722-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97299207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty