Healthcare Provider Details

I. General information

NPI: 1083149819
Provider Name (Legal Business Name): ELLIE NAZER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAHEHNAZER NAZERZADEH DC

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 CROUCH ST STE 100
OCEANSIDE CA
92054-4460
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 760-736-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: