Healthcare Provider Details

I. General information

NPI: 1295091825
Provider Name (Legal Business Name): NASRIN NAIMI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 MOWRY AVE FLOOR 1
FREMONT CA
94538-1621
US

IV. Provider business mailing address

PO BOX 211638
AUGUSTA GA
30917-1638
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-5374
  • Fax: 510-790-8916
Mailing address:
  • Phone: 706-860-2701
  • Fax: 706-860-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: NASRIN SIDDIQ NAIMI
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 510-791-5374