Healthcare Provider Details

I. General information

NPI: 1225759970
Provider Name (Legal Business Name): NANDA NEUROVASCULAR ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E VALENCIA MESA DR
FULLERTON CA
92835-3809
US

IV. Provider business mailing address

2271 W MALVERN AVE # 72
FULLERTON CA
92833-2106
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-3280
  • Fax:
Mailing address:
  • Phone: 216-820-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHISH NANDA
Title or Position: OWNER
Credential: MD
Phone: 216-820-1366