Healthcare Provider Details

I. General information

NPI: 1215064209
Provider Name (Legal Business Name): NASRA SAWAL HAROUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

IV. Provider business mailing address

5475 BRAGG ST
SAN DIEGO CA
92122-4103
US

V. Phone/Fax

Practice location:
  • Phone: 619-397-6922
  • Fax: 619-421-7186
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA044035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: