Provider Demographics
NPI:1538710223
Name:MASIHI-NAZARI, ARTIN
Entity type:Individual
Prefix:
First Name:ARTIN
Middle Name:
Last Name:MASIHI-NAZARI
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 1:18711 SHERMAN WAY UNIT 106C
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4086
Mailing Address - Country:US
Mailing Address - Phone:818-818-4697
Mailing Address - Fax:
Practice Address - Street 1:18711 SHERMAN WAY UNIT 106C
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4086
Practice Address - Country:US
Practice Address - Phone:818-818-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACVOP1915290343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)