Provider Demographics
NPI:1679718217
Name:NASSERI, KAYNAZ
Entity type:Individual
Prefix:MRS
First Name:KAYNAZ
Middle Name:
Last Name:NASSERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ARCADE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0119
Mailing Address - Country:US
Mailing Address - Phone:949-648-1910
Mailing Address - Fax:
Practice Address - Street 1:25 ARCADE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-0119
Practice Address - Country:US
Practice Address - Phone:949-648-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 227151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical