Healthcare Provider Details

I. General information

NPI: 1356972798
Provider Name (Legal Business Name): ANDREW NASSERI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

1150 CRESTHILL PL
EL CAJON CA
92021-3303
US

V. Phone/Fax

Practice location:
  • Phone: 209-222-0801
  • Fax:
Mailing address:
  • Phone: 209-209-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW NASSERI
Title or Position: MANAGER
Credential:
Phone: 209-222-0801