Provider Demographics
NPI:1164516043
Name:NANDA, NIRMALA T (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:T
Last Name:NANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 ARTESIA BLVD
Mailing Address - Street 2:SUITE 607
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3014
Mailing Address - Country:US
Mailing Address - Phone:310-318-2521
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-437-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41178208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18427Medicare UPIN