Healthcare Provider Details

I. General information

NPI: 1265626329
Provider Name (Legal Business Name): DR. NASHWA NOEL GEBRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

1247 JAMACHA RD
EL CAJON CA
92019-3662
US

V. Phone/Fax

Practice location:
  • Phone: 619-328-1335
  • Fax: 619-328-1336
Mailing address:
  • Phone: 800-417-4444
  • Fax: 714-571-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: