Healthcare Provider Details

I. General information

NPI: 1528788783
Provider Name (Legal Business Name): KRISTEN M NASSERY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

IV. Provider business mailing address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-5352
  • Fax: 760-724-5447
Mailing address:
  • Phone: 760-724-5352
  • Fax: 760-724-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN MARIE NASSERY
Title or Position: PRESIDENT, SECRETARY, AND TREASURER
Credential: MD
Phone: 859-468-1742