Healthcare Provider Details

I. General information

NPI: 1538124300
Provider Name (Legal Business Name): SAMEER BASHIR QURESHI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

IV. Provider business mailing address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

V. Phone/Fax

Practice location:
  • Phone: 213-673-4849
  • Fax: 213-673-4581
Mailing address:
  • Phone: 213-673-4849
  • Fax: 213-673-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP11768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: