Provider Demographics
NPI:1215950613
Name:NASSERI, BITA HAFEZIZADEH (MD)
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:HAFEZIZADEH
Last Name:NASSERI
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:PO BOX 60790
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-6790
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:#110
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:310-659-2400
Practice Address - Fax:310-659-2452
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71012207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A710120OtherBLUE SHIELD
CABM012ZMedicare PIN
CA00A710120OtherBLUE SHIELD
H76275Medicare UPIN