Healthcare Provider Details

I. General information

NPI: 1770589293
Provider Name (Legal Business Name): RAED A AL-NASER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR STE 609
LA MESA CA
91942-3009
US

IV. Provider business mailing address

PO BOX 2535
LA MESA CA
91943-2535
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-9158
  • Fax: 619-462-0371
Mailing address:
  • Phone: 888-664-8297
  • Fax: 866-313-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA71932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA71932
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA71932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: