Provider Demographics
NPI:1073373601
Name:VERDUGO MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:VERDUGO MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABOO
Authorized Official - Middle Name:
Authorized Official - Last Name:NASAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-588-3705
Mailing Address - Street 1:142 W VERDUGO AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2132
Mailing Address - Country:US
Mailing Address - Phone:818-588-3705
Mailing Address - Fax:818-588-3685
Practice Address - Street 1:142 W VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2132
Practice Address - Country:US
Practice Address - Phone:818-588-3705
Practice Address - Fax:818-588-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty