Healthcare Provider Details

I. General information

NPI: 1982697694
Provider Name (Legal Business Name): LARRY NESTOR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W CAMERON AVE STE 100
WEST COVINA CA
91790-2723
US

IV. Provider business mailing address

1750 W CAMERON AVE STE 100
WEST COVINA CA
91790-2723
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-3061
  • Fax:
Mailing address:
  • Phone: 626-960-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG26496
License Number StateCA

VIII. Authorized Official

Name: LARRY NESTOR
Title or Position: PRESIDENT
Credential: MD
Phone: 562-426-7935