Provider Demographics
NPI:1831367762
Name:NASSIRI, ALI (DO)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:NASSIRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21201
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-1201
Mailing Address - Country:US
Mailing Address - Phone:951-529-7890
Mailing Address - Fax:951-686-2168
Practice Address - Street 1:1809 VERDUGO BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9369207L00000X, 207LP2900X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831367762Medicaid
CA1831367762Medicaid
CAP00675201Medicare PIN
CAAY731ZMedicare PIN