Provider Demographics
NPI:1255301024
Name:NASSIR, JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:NASSIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:#430
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7508
Mailing Address - Country:US
Mailing Address - Phone:714-843-6800
Mailing Address - Fax:714-847-3480
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:#430
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7508
Practice Address - Country:US
Practice Address - Phone:714-843-6800
Practice Address - Fax:714-847-3480
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18378Medicare UPIN
A52865Medicare ID - Type Unspecified