Provider Demographics
NPI:1124070255
Name:NAZIRPOUR-CALOOR, SEYED-HASSAN (CNP)
Entity type:Individual
Prefix:
First Name:SEYED-HASSAN
Middle Name:
Last Name:NAZIRPOUR-CALOOR
Suffix:
Gender:M
Credentials:CNP
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 2745
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-2745
Mailing Address - Country:US
Mailing Address - Phone:575-623-6161
Mailing Address - Fax:575-623-6464
Practice Address - Street 1:612 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4808
Practice Address - Country:US
Practice Address - Phone:575-623-6161
Practice Address - Fax:575-623-6464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47987359Medicaid
NM47987359Medicaid