| P.b. Nikravesh Dpm, Apc | |
|
6404 Wilshire Blvd Ste 600, Los Angeles, CA 90048-5501 | |
| (323) 782-8586 | |
| (323) 782-8528 |
| Full Name | P.b. Nikravesh Dpm, Apc |
|---|---|
| Type | Facility |
| Speciality | Podiatrist - Primary Podiatric Medicine |
| Location | 6404 Wilshire Blvd Ste 600, Los Angeles, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083969018 | NPI | - | NPPES |
| 000E41032 | Medicaid | CA | |
| E4103 | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213EP1101X | Podiatrist - Primary Podiatric Medicine | E4103 (California) | Primary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | E4103 (California) | Secondary |
| Provider Name | Payam Nikravesh |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1437192200 PECOS PAC ID: 8022001783 Enrollment ID: I20040407000773 |
| Mailing Address | Practice Location Address |
|---|---|
| P.b. Nikravesh Dpm, Apc 6404 Wilshire Blvd Ste 600, Los Angeles, CA 90048-5501 Ph: (323) 782-8586 | P.b. Nikravesh Dpm, Apc 6404 Wilshire Blvd Ste 600, Los Angeles, CA 90048-5501 Ph: (323) 782-8586 |
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