Healthcare Provider Details

I. General information

NPI: 1871790717
Provider Name (Legal Business Name): NADER NASHAAT ATTIA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 12/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 ELIZABETH ST
RIVERSIDE CA
92506-2527
US

IV. Provider business mailing address

3770 ELIZABETH ST
RIVERSIDE CA
92506-2527
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3937
  • Fax:
Mailing address:
  • Phone: 951-352-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101017289
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20A12778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: