MEDICARE: MR. AVI NASH

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1659197127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AVI NASH

Provider Business Mailing Address
First Line	:	PO BOX 451
Second Line	:
City	:	SIERRA BLANCA
State	:	TX
Zip	:	79851-0451
Country	:	US
Telephone Number	:	830-282-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1195 EL PASO ST # 451
Second Line	:
City	:	SIERRA BLANCA
State	:	TX
Zip	:	79851-9800
Country	:	US
Telephone Number	:	830-282-7942
Fax Number	:

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

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	11/29/2024

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