Provider Demographics
NPI:1902498710
Name:MOEZZI, NIMA
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:MOEZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 CANOGA AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6654
Mailing Address - Country:US
Mailing Address - Phone:818-438-2229
Mailing Address - Fax:
Practice Address - Street 1:5565 CANOGA AVE APT 312
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6654
Practice Address - Country:US
Practice Address - Phone:818-438-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist