Provider Demographics
NPI:1144767211
Name:EL-MOGHRABI, NANCY (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:EL-MOGHRABI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E VIA RANCHO PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-8005
Mailing Address - Country:US
Mailing Address - Phone:760-480-4500
Mailing Address - Fax:
Practice Address - Street 1:290 E VIA RANCHO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-8005
Practice Address - Country:US
Practice Address - Phone:586-468-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005031152W00000X
CA34125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144767211OtherMEDICARE
CA1144767211Medicaid