Provider Demographics
NPI:1619238342
Name:NAZEMI, NAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:NAVID
Middle Name:
Last Name:NAZEMI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74000 COUNTRY CLUB DR STE A5
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1677
Mailing Address - Country:US
Mailing Address - Phone:760-773-3400
Mailing Address - Fax:760-771-3200
Practice Address - Street 1:74000 COUNTRY CLUB DR STE A5
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1677
Practice Address - Country:US
Practice Address - Phone:760-773-3400
Practice Address - Fax:760-771-3200
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GF049AOtherMEDICARE PTAN