Provider Demographics
NPI:1336227263
Name:NABAVI, NOSRAT ALLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NOSRAT
Middle Name:ALLAH
Last Name:NABAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:ALLAH
Other - Last Name:NABAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 LOMITA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4900
Mailing Address - Country:US
Mailing Address - Phone:310-540-0965
Mailing Address - Fax:310-540-6721
Practice Address - Street 1:3400 LOMITA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4900
Practice Address - Country:US
Practice Address - Phone:310-540-0965
Practice Address - Fax:310-540-6721
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA341240Medicaid
CAA84572Medicare UPIN
CAWA34124CMedicare ID - Type Unspecified
CAWA34124DMedicare ID - Type Unspecified
CAOOA341240Medicaid