Provider Demographics
NPI:1770917585
Name:REZAPOUR, NAHID
Entity type:Individual
Prefix:
First Name:NAHID
Middle Name:
Last Name:REZAPOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1833
Mailing Address - Country:US
Mailing Address - Phone:213-202-3970
Mailing Address - Fax:213-241-0925
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:STE 209
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5218
Practice Address - Country:US
Practice Address - Phone:818-205-1200
Practice Address - Fax:818-205-1254
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program