Healthcare Provider Details

I. General information

NPI: 1922652916
Provider Name (Legal Business Name): NADA EL-GHEZZAOUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BROOME ST FL 2
NEW YORK NY
10013-3569
US

IV. Provider business mailing address

14632 SWEETAN ST
IRVINE CA
92604-2428
US

V. Phone/Fax

Practice location:
  • Phone: 646-650-5337
  • Fax: 646-871-6820
Mailing address:
  • Phone: 949-214-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030815
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: