Provider Demographics
NPI:1790150555
Name:NAZARI, MAHMOOD
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:NAZARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 LAKE APOPKA PL
Mailing Address - Street 2:6209 LAKE APOPKA PLACE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3520
Mailing Address - Country:US
Mailing Address - Phone:161-989-0392
Mailing Address - Fax:161-940-4418
Practice Address - Street 1:6209 LAKE APOPKA PL
Practice Address - Street 2:6209 LAKE APOPKA PLACE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3520
Practice Address - Country:US
Practice Address - Phone:161-989-0392
Practice Address - Fax:161-940-4418
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist