Provider Demographics
NPI:1578770806
Name:MATLOUBI, NADER (MD)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:MATLOUBI
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 1:12677 HESPERIA RD STE 190
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7754
Mailing Address - Country:US
Mailing Address - Phone:760-243-1234
Mailing Address - Fax:708-223-8730
Practice Address - Street 1:12818 HEACOCK ST STE C2
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3173
Practice Address - Country:US
Practice Address - Phone:951-242-2508
Practice Address - Fax:951-242-2548
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1089622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A831350Medicaid
CAWA83135AMedicare PIN
CA00A831350Medicare PIN
CA00A831351Medicare PIN