Provider Demographics
NPI:1518179225
Name:NADERI, MOHAMMAD JAVAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:JAVAD
Last Name:NADERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAVAD
Other - Middle Name:M
Other - Last Name:NADERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-5000
Mailing Address - Country:US
Mailing Address - Phone:661-326-2534
Mailing Address - Fax:661-326-2888
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-326-2534
Practice Address - Fax:661-326-2888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303732085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL 114091OtherRADIOLOGY X-RAY SUPERVISOR AND OPERATOR