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General NPI Number Information
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NPI Number | 1356568034
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Entity Type | Organization
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Legal Business Name | THEODORE R. NASSAR MD, FACOG, INC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 126 W OLIVE AVE STE 101
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City | MADERA
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State | CA
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Zip | 93637-3200
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Country | US
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Telephone | 559-674-0917
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Fax | 559-674-3104
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Provider Business Mailing Address
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Address Line | 363 E ALMOND AVE SUITE 101
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City | MADERA
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State | CA
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Zip | 93637
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Country | US
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Telephone | 559-674-0917
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Fax | 559-674-3104
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | MRS. AIDA NASSAR
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Credential | BA
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Telephone | 559-674-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 207VX0000
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License Number State | CA
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