Provider Demographics
NPI:1609202308
Name:ALDAHHAN, NADINE (DO)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:ALDAHHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HARBOR DR STE 111
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1491
Mailing Address - Country:US
Mailing Address - Phone:415-683-2988
Mailing Address - Fax:415-683-2900
Practice Address - Street 1:3 HARBOR DR STE 111
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1491
Practice Address - Country:US
Practice Address - Phone:415-683-2988
Practice Address - Fax:415-683-2900
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14150207PE0004X, 207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A14150OtherSTATE MEDICAL LICENSE