Provider Demographics
NPI:1013023498
Name:NAZLI AHMED, M.D., INC.
Entity Type:Organization
Organization Name:NAZLI AHMED, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAZLI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-642-5390
Mailing Address - Street 1:275 VICTORIA ST
Mailing Address - Street 2:# 2M
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1906
Mailing Address - Country:US
Mailing Address - Phone:949-642-5390
Mailing Address - Fax:949-642-1224
Practice Address - Street 1:275 VICTORIA ST
Practice Address - Street 2:# 2M
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1906
Practice Address - Country:US
Practice Address - Phone:949-642-5390
Practice Address - Fax:949-642-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A347440Medicaid
A34744Medicare ID - Type Unspecified
CA00A347440Medicaid