Healthcare Provider Details

I. General information

NPI: 1659364271
Provider Name (Legal Business Name): HAFEZ ALI NASR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N H ST
LOMPOC CA
93436-3301
US

IV. Provider business mailing address

1515 E OCEAN AVE
LOMPOC CA
93436-7092
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-8700
  • Fax: 780-573-8701
Mailing address:
  • Phone: 805-737-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC156000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: