Healthcare Provider Details

I. General information

NPI: 1265689335
Provider Name (Legal Business Name): FRANK NASTANSKI MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE SUITE 116
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

999 N TUSTIN AVE SUITE 116
SANTA ANA CA
92705-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-1915
  • Fax: 714-547-6552
Mailing address:
  • Phone: 714-547-1915
  • Fax: 714-547-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA68851
License Number StateCA

VIII. Authorized Official

Name: MS. MARY ZAZUETTA
Title or Position: INSURANCE BILLING REPRESENTATIVE
Credential:
Phone: 714-547-1915