Individual
MASTANEH NIKRAVESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(619) 740-6000
Mailing address
600 1ST AVE STE 102-2405, SEATTLE, WA 98104-2210
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A176795
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
A176795
CA
208VP0000X
Pain Medicine Physician
Primary
A176795
CA
Other
Enumeration date
04/18/2019
Last updated
03/11/2025
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