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General NPI Number Information
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NPI Number | 1932383783
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Entity Type | Individual
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Provider Name | NINA MOLAYEM NATTIV BA, DDS
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Gender | Female
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 3110 KERNER BLVD
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City | SAN RAFAEL
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State | CA
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Zip | 94901-5411
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Country | US
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Telephone | 310-995-9987
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Fax |
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Provider Business Mailing Address
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Address Line | 9675 BRIGHTON WAY #210
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5100
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Country | US
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Telephone | 310-995-9987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56690
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25156
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License Number State | TX
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