Provider Demographics
NPI:1851449987
Name:NABAVI, REZA RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:RAY
Last Name:NABAVI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5641
Mailing Address - Country:US
Mailing Address - Phone:310-893-3255
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5641
Practice Address - Country:US
Practice Address - Phone:310-893-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical