Provider Demographics
NPI:1588778773
Name:RIAZATI, NASIM (MD)
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:RIAZATI
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 10429
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-0429
Mailing Address - Country:US
Mailing Address - Phone:714-415-4050
Mailing Address - Fax:714-415-4053
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:562-933-1245
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80835207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00345525OtherRAILROAD MEDICARE ID #
CA00A808350Medicaid
CA00A808350OtherBLUE SHIELD ID #
CA00A808350385OtherCALOPTIMA ID #
CAI31730Medicare UPIN
CA00A808350Medicaid