Provider Demographics
NPI:1336106640
Name:NASHED, EZZAT A (MD)
Entity Type:Individual
Prefix:DR
First Name:EZZAT
Middle Name:A
Last Name:NASHED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 BEAR VALLEY RD
Mailing Address - Street 2:STE 102
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8764
Mailing Address - Country:US
Mailing Address - Phone:760-962-0077
Mailing Address - Fax:760-967-1098
Practice Address - Street 1:16200 BEAR VALLEY RD
Practice Address - Street 2:STE 102
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8764
Practice Address - Country:US
Practice Address - Phone:760-962-0077
Practice Address - Fax:760-967-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487713Medicaid
A48771OtherLIC #
A48771OtherLIC #
F58602Medicare UPIN
A48771OtherLIC #