Provider Demographics
NPI:1578760641
Name:NAM, EDUARDO JUAN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:JUAN
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3817
Mailing Address - Country:US
Mailing Address - Phone:951-929-1333
Mailing Address - Fax:951-929-1377
Practice Address - Street 1:1515 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3817
Practice Address - Country:US
Practice Address - Phone:951-929-1333
Practice Address - Fax:951-929-1377
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-30
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85422207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology