Healthcare Provider Details

I. General information

NPI: 1578760641
Provider Name (Legal Business Name): EDUARDO JUAN NAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2007
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W FLORIDA AVE
HEMET CA
92543-3817
US

IV. Provider business mailing address

1515 W FLORIDA AVE
HEMET CA
92543-3817
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-1333
  • Fax: 951-929-1377
Mailing address:
  • Phone: 951-929-1333
  • Fax: 951-929-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA85422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: