Provider Demographics
NPI:1730989898
Name:NIKPOUR, ALIREZA (PMHNP)
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:NIKPOUR
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E OLIVE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5255
Mailing Address - Country:US
Mailing Address - Phone:952-517-3701
Mailing Address - Fax:951-269-4032
Practice Address - Street 1:104 E OLIVE AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5255
Practice Address - Country:US
Practice Address - Phone:952-517-3701
Practice Address - Fax:951-269-4032
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95034076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health