Healthcare Provider Details

I. General information

NPI: 1831478395
Provider Name (Legal Business Name): SAMAR NAHAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19330 JESSE LN STE 100
RIVERSIDE CA
92508-5077
US

IV. Provider business mailing address

19330 JESSE LN STE 100
RIVERSIDE CA
92508-5077
US

V. Phone/Fax

Practice location:
  • Phone: 951-776-5545
  • Fax:
Mailing address:
  • Phone: 951-776-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA137858
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number44372
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: