Provider Demographics
NPI:1982585980
Name:MASTANEH NIKRAVESH MD PC
Entity type:Organization
Organization Name:MASTANEH NIKRAVESH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASTANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKRAVESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-869-9953
Mailing Address - Street 1:600 1ST AVE STE 102-2405
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2210
Mailing Address - Country:US
Mailing Address - Phone:619-940-7934
Mailing Address - Fax:
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:619-940-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty