Provider Demographics
NPI:1346537974
Name:NASSER, MARYAM DINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:DINA
Last Name:NASSER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARYAM
Other - Middle Name:DINA
Other - Last Name:NASSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:27982 LA PAZ RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3921
Mailing Address - Country:US
Mailing Address - Phone:949-360-8215
Mailing Address - Fax:
Practice Address - Street 1:27982 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3921
Practice Address - Country:US
Practice Address - Phone:949-360-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist