Provider Demographics
NPI:1821686627
Name:NAZERZADEH, ATTAH
Entity Type:Individual
Prefix:
First Name:ATTAH
Middle Name:
Last Name:NAZERZADEH
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 1:2 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5011
Mailing Address - Country:US
Mailing Address - Phone:310-308-0944
Mailing Address - Fax:
Practice Address - Street 1:2 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-5011
Practice Address - Country:US
Practice Address - Phone:310-308-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist