Provider Demographics
NPI:1073594636
Name:NASSER, THOMAS S (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:NASSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3053 RANCHO VISTA BLVD
Mailing Address - Street 2:SUITE H, # 195
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4823
Mailing Address - Country:US
Mailing Address - Phone:661-729-3388
Mailing Address - Fax:661-726-5377
Practice Address - Street 1:43847 HEATON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4936
Practice Address - Country:US
Practice Address - Phone:661-729-3388
Practice Address - Fax:661-726-5377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8971208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
I26504Medicare UPIN
CAW20A8971BMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #