Provider Demographics
NPI:1568400539
Name:NASRIN RAHAVI
Entity Type:Organization
Organization Name:NASRIN RAHAVI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-759-9110
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE # 602-A
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-759-9110
Mailing Address - Fax:949-759-9118
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE # 602-A
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-759-9110
Practice Address - Fax:949-759-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center