Provider Demographics
NPI:1699209163
Name:KAZEMI, NASRIN
Entity Type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:KAZEMI
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 1:3200 INLAND EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5513
Mailing Address - Country:US
Mailing Address - Phone:909-945-5011
Mailing Address - Fax:909-989-6158
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-6558
Practice Address - Fax:909-558-6701
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine