MEDICARE: NASTARAN FATHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G1895	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407957657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASTARAN FATHI MD

Provider Business Mailing Address
First Line	:	215 E QUINCY
Second Line	:	420
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215
Country	:	US
Telephone Number	:	210-222-9997
Fax Number	:	210-222-2939

Provider Business Practice Location Address
First Line	:	215 E QUINCY ST
Second Line	:	420
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-2039
Country	:	US
Telephone Number	:	210-222-9997
Fax Number	:	210-222-2939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/21/2010

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Directions to “ NASTARAN FATHI MD” Practice Location

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