Healthcare Provider Details

I. General information

NPI: 1194944066
Provider Name (Legal Business Name): NAWAL NAZEER ROFAEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11938 S HAWTHORNE BLVD
HAWTHORNE CITY CA
90250-3016
US

IV. Provider business mailing address

11938 S HAWTHORNE BLVD
HAWTHORNE CITY CA
90250-3016
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-0945
  • Fax: 310-973-2135
Mailing address:
  • Phone: 310-973-0945
  • Fax: 310-973-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: