Provider Demographics
NPI:1568113405
Name:NASERI, ZALASH
Entity Type:Individual
Prefix:
First Name:ZALASH
Middle Name:
Last Name:NASERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S JACKSON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1594
Mailing Address - Country:US
Mailing Address - Phone:310-595-2811
Mailing Address - Fax:
Practice Address - Street 1:240 S JACKSON ST STE 109
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1594
Practice Address - Country:US
Practice Address - Phone:310-595-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty