Provider Demographics
NPI:1255419818
Name:MOAYERI, N. NICOLE (MD)
Entity type:Individual
Prefix:
First Name:N. NICOLE
Middle Name:
Last Name:MOAYERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93102-0689
Mailing Address - Country:US
Mailing Address - Phone:805-569-7820
Mailing Address - Fax:805-569-7414
Practice Address - Street 1:2410 FLETCHER AVE FL 3
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4876
Practice Address - Country:US
Practice Address - Phone:805-569-7820
Practice Address - Fax:805-569-7414
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69761207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697610Medicaid
CA00G697610Medicaid
00G697610Medicare ID - Type Unspecified