Healthcare Provider Details

I. General information

NPI: 1144455262
Provider Name (Legal Business Name): BASMA AL NAHLAWI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W SAN MARCOS BLVD STE 210
SAN MARCOS CA
92078-1147
US

IV. Provider business mailing address

PO BOX 511475
LOS ANGELES CA
90051-8030
US

V. Phone/Fax

Practice location:
  • Phone: 760-707-6765
  • Fax: 760-736-8092
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA115924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: