Healthcare Provider Details

I. General information

NPI: 1043833841
Provider Name (Legal Business Name): KEVIN NASRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CITRACADO PKWY STE 203
ESCONDIDO CA
92029-4112
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 760-738-5533
  • Fax: 760-738-3835
Mailing address:
  • Phone: 760-738-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A20323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: