Provider Demographics
NPI:1043227747
Name:RAED AL-NASER, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAED AL-NASER, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAED
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:AL-NASER
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:888-664-8297
Mailing Address - Street 1:PO BOX 2535
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2535
Mailing Address - Country:US
Mailing Address - Phone:888-664-8297
Mailing Address - Fax:866-313-8916
Practice Address - Street 1:5525 GROSSMONT CENTER DR STE 609
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3009
Practice Address - Country:US
Practice Address - Phone:619-589-9158
Practice Address - Fax:619-462-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71932207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12522Medicare UPIN
CAW20237Medicare PIN