Individual provider Active NPI

Roshana Amir Nazari

  • Psychiatric/Mental Health Nurse Practitioner
  • Redlands, CA
National Provider Identifier
1104647205
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95032224 Issued in CA
Practice address
1030 Nevada St Ste 101
Redlands, CA 92374-2957
Phone
(909) 966-5500
NPI assigned
Oct 21, 2024
Last updated
Oct 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95032224 CA Primary

Addresses

Primary practice location

1030 Nevada St Ste 101
Redlands, CA 92374-2957

Mailing address

1030 Nevada St Suite 101
Redlands, CA 92374
Phone (714) 468-4177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241226001675 CA Practitioner - Nurse Practitioner 8426585753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Drexel University College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
David Desai MD IncGroup PAC ID 6204148794, 9 clinicians

Practice addresses (Care Compare)

1030 Nevada St
Suite 101
Redlands, CA 92374-2957

2131 Elks Dr
Suite 104
San Bernardino, CA 92404-5571
Phone (909) 966-5500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
David Desai MD Inc CurrentSince Nov 1, 2024 Accepting new patients

Locations

1030 Nevada St
Ste 101
Redlands, CA 92374
Phone (909) 362-3727

2131 Elks Dr
Ste 104
Sn Bernrdno, CA 92404
Phone (909) 966-5500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1104647205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 NEVADA ST SUITE 101",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "92374",
            "telephone_number": "714-468-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NEVADA ST STE 101",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742957",
            "telephone_number": "909-966-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAZARI",
        "first_name": "ROSHANA",
        "middle_name": "AMIR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95032224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.