Provider Demographics
NPI:1447293626
Name:NAYERSINA, HOOSHMAND (MD)
Entity type:Individual
Prefix:DR
First Name:HOOSHMAND
Middle Name:
Last Name:NAYERSINA
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 1:912 WAVERLY CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7502
Mailing Address - Country:US
Mailing Address - Phone:925-245-0209
Mailing Address - Fax:925-245-0209
Practice Address - Street 1:4951 ARROYO RD
Practice Address - Street 2:VAPAHCS LIVERMORE DIVISION
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-4700
Practice Address - Fax:925-449-6410
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24624Medicare UPIN
CAA25888Medicare ID - Type UnspecifiedPREVIOUS PRIVATE PRACTICE