Provider Demographics
NPI:1144510041
Name:FAYAZMANESH, NIMA (MD)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:FAYAZMANESH
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 1:5901 EAST 7TH STREET
Mailing Address - Street 2:MENTAL HEALTH CARE GROUP - 06/116A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 EAST 7TH STREET
Practice Address - Street 2:MENTAL HEALTH CARE GROUP - 06/116A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1236132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry