Provider Demographics
NPI:1487704284
Name:NAZERI, BAHMAN (MD)
Entity type:Individual
Prefix:
First Name:BAHMAN
Middle Name:
Last Name:NAZERI
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 1:6130 ROSY LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3971
Mailing Address - Country:US
Mailing Address - Phone:916-944-4390
Mailing Address - Fax:
Practice Address - Street 1:6130 ROSY LN
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3971
Practice Address - Country:US
Practice Address - Phone:916-944-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48772208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487720Medicaid
00A487720Medicare ID - Type Unspecified
F91411Medicare UPIN