Provider Demographics
NPI:1922554807
Name:NASSIRI, ARASH BRIAN
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:BRIAN
Last Name:NASSIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ARY
Other - Middle Name:BRIAN
Other - Last Name:NASSIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25781 MAPLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7549
Mailing Address - Country:US
Mailing Address - Phone:949-505-2948
Mailing Address - Fax:
Practice Address - Street 1:204 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2623
Practice Address - Country:US
Practice Address - Phone:310-396-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78209101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program