Provider Demographics
NPI:1508896515
Name:MASHOUR, NICK (MD)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:MASHOUR
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:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-1867
Mailing Address - Country:US
Mailing Address - Phone:714-540-5900
Mailing Address - Fax:714-540-5906
Practice Address - Street 1:125 BAKER ST E
Practice Address - Street 2:SUITE 180
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4509
Practice Address - Country:US
Practice Address - Phone:714-540-5900
Practice Address - Fax:714-540-5906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72007Medicare ID - Type Unspecified