Healthcare Provider Details

I. General information

NPI: 1003523663
Provider Name (Legal Business Name): NADI MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 70TH ST
LA MESA CA
91942-0701
US

IV. Provider business mailing address

4535 70TH ST
LA MESA CA
91942-0701
US

V. Phone/Fax

Practice location:
  • Phone: 619-750-4962
  • Fax:
Mailing address:
  • Phone: 619-609-9294
  • Fax: 619-720-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MASOUD NADI
Title or Position: OWNER/PRESIDENT
Credential: FNP
Phone: 619-609-9492