Provider Demographics
NPI:1609986975
Name:EITAN, NATHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:EITAN
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 1:9200 COLIMA RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605
Mailing Address - Country:US
Mailing Address - Phone:562-945-2833
Mailing Address - Fax:562-945-3883
Practice Address - Street 1:9200 COLIMA RD
Practice Address - Street 2:STE 200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605
Practice Address - Country:US
Practice Address - Phone:562-945-2833
Practice Address - Fax:562-945-3883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36074207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360740Medicaid
B50307Medicare UPIN
CA00A360740Medicaid