Provider Demographics
NPI:1861430373
Name:FATEMI, NASTARAN (MD)
Entity type:Individual
Prefix:DR
First Name:NASTARAN
Middle Name:
Last Name:FATEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA874042085R0202X
IAMD-461892085R0202X
NMMD2024-00532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A874040Medicaid
CA00A874040OtherBLUE SHIELD
CAGR0106035Medicaid
CAGR0106039Medicaid
CA00A874040Medicaid
CAWA87404RMedicare PIN
CAWA87404FMedicare PIN
CA00A874048Medicare PIN
CAWA87404QMedicare PIN
AR00A8740410Medicare PIN
CAWA87404AMedicare PIN
CAWA87404IMedicare PIN
CA00A874042Medicare PIN
CA00A874045Medicare PIN
CAGR0106039Medicaid
CA00A874044Medicare PIN
CA00A874047Medicare PIN
CAWA87404SMedicare PIN
CAWA87404GMedicare PIN
CAWA87404PMedicare PIN
CAWA87404TMedicare PIN
CAGR0106035Medicaid
CA00A874043Medicare PIN