Provider Demographics
NPI:1902919889
Name:MEHRIZI, NASSER Z (MD)
Entity Type:Individual
Prefix:
First Name:NASSER
Middle Name:Z
Last Name:MEHRIZI
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 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-630-0050
Mailing Address - Fax:
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-630-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48610208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486101Medicaid
CAF15252Medicare UPIN
CAA48610Medicare ID - Type Unspecified