Provider Demographics
NPI:1770718967
Name:NABAVI, MAZIAR (MD)
Entity type:Individual
Prefix:MR
First Name:MAZIAR
Middle Name:
Last Name:NABAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BAY SHORE AVE UNIT 304
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3539
Mailing Address - Country:US
Mailing Address - Phone:310-504-4609
Mailing Address - Fax:
Practice Address - Street 1:12923 INGLEWOOD AVE STE 1
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5573
Practice Address - Country:US
Practice Address - Phone:310-675-0395
Practice Address - Fax:310-675-0395
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA127123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
06611982OtherEDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES (ECFMG)