Healthcare Provider Details

I. General information

NPI: 1346447893
Provider Name (Legal Business Name): AARTI MANOHAR NASTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WARREN ST SUITE 302
REDWOOD CITY CA
94063-1578
US

IV. Provider business mailing address

415 TESCONI CIR
SANTA ROSA CA
95401-4619
US

V. Phone/Fax

Practice location:
  • Phone: 650-701-1882
  • Fax: 650-701-1886
Mailing address:
  • Phone: 707-578-1175
  • Fax: 707-578-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: