Provider Demographics
NPI:1588816425
Name:TEHRANI, ALIREZA NIKBAKSH (DO)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:NIKBAKSH
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17868 US HIGHWAY 18
Mailing Address - Street 2:#357
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1267
Mailing Address - Country:US
Mailing Address - Phone:760-927-2002
Mailing Address - Fax:
Practice Address - Street 1:19341 BEAR VALLEY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5151
Practice Address - Country:US
Practice Address - Phone:760-240-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012696208200000X
CA20A10839208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery