Provider Demographics
NPI:1710549878
Name:HAJIANNASAB, RASAM (MD)
Entity type:Individual
Prefix:
First Name:RASAM
Middle Name:
Last Name:HAJIANNASAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-4673
Mailing Address - Fax:
Practice Address - Street 1:20001 S RANCHO WAY
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-6318
Practice Address - Country:US
Practice Address - Phone:310-225-3221
Practice Address - Fax:310-698-7040
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA193348207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology