Provider Demographics
NPI:1538146840
Name:NAZO, SAMIR AK (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:AK
Last Name:NAZO
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 1:2307 W EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3318
Mailing Address - Country:US
Mailing Address - Phone:818-841-3420
Mailing Address - Fax:818-841-5171
Practice Address - Street 1:2307 W EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3318
Practice Address - Country:US
Practice Address - Phone:818-841-3420
Practice Address - Fax:818-841-5171
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38614208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38614OtherSTATE LIC
CA00A386140Medicaid
CA00A386140Medicaid