Provider Demographics
NPI:1104115195
Name:BASIRATMAND, NEJAT (MD)
Entity type:Individual
Prefix:MR
First Name:NEJAT
Middle Name:
Last Name:BASIRATMAND
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 1:17740 BURBANK BLVD
Mailing Address - Street 2:# 101
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1648
Mailing Address - Country:US
Mailing Address - Phone:818-517-0463
Mailing Address - Fax:213-384-7125
Practice Address - Street 1:17740 BURBANK BLVD
Practice Address - Street 2:# 101
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1648
Practice Address - Country:US
Practice Address - Phone:818-517-0463
Practice Address - Fax:213-384-7125
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8616A146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant