Provider Demographics
NPI:1568406866
Name:GOLZAR, NASIM (MD)
Entity Type:Individual
Prefix:
First Name:NASIM
Middle Name:
Last Name:GOLZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26516 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3970
Mailing Address - Country:US
Mailing Address - Phone:310-541-7911
Mailing Address - Fax:310-541-2953
Practice Address - Street 1:26516 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3970
Practice Address - Country:US
Practice Address - Phone:310-541-7911
Practice Address - Fax:310-541-2953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA48165AMedicare ID - Type Unspecified
CAF49276Medicare UPIN