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General NPI Number Information
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NPI Number | 1639360118
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Entity Type | Organization
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Legal Business Name | NESTOR N. NAZARENO MD PC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 14420 W MEEKER BLVD STE 109
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-5287
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Country | US
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Telephone | 623-544-3522
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Fax | 623-544-3520
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Provider Business Mailing Address
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Address Line | 14420 W MEEKER BLVD STE 109
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-5287
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Country | US
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Telephone | 623-544-3522
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Fax | 623-544-3520
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. CATHERINE MARIE AGREDASALAS
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Credential | M.A.
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Telephone | 623-544-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 23491
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License Number State | AZ
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