Healthcare Provider Details

I. General information

NPI: 1366295263
Provider Name (Legal Business Name): EANASHMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LA CASA VIA STE 260
WALNUT CREEK CA
94598-3012
US

IV. Provider business mailing address

PO BOX 6119
LA QUINTA CA
92248-6119
US

V. Phone/Fax

Practice location:
  • Phone: 925-239-2900
  • Fax: 760-691-2952
Mailing address:
  • Phone: 760-899-7858
  • Fax: 760-691-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC ANTHONY NASH
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 760-899-7858