Provider Demographics
NPI:1104028448
Name:SAMI B. NAZZAL, M.D., F.A.C.C. INC.
Entity Type:Organization
Organization Name:SAMI B. NAZZAL, M.D., F.A.C.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:BARHAM
Authorized Official - Last Name:NAZZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-7400
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-881-7400
Mailing Address - Fax:909-881-7404
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-881-7400
Practice Address - Fax:909-881-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30933207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079880Medicaid
CAA26283Medicare UPIN
CAGR0079880Medicaid