Provider Demographics
NPI:1619014776
Name:NASTASKIN, IGOR J (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:J
Last Name:NASTASKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:361 TOWN CENTER WEST SUITE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-922-6581
Mailing Address - Fax:805-348-3217
Practice Address - Street 1:361 TOWN CENTER WEST SUITE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-922-6581
Practice Address - Fax:805-348-3217
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA93318207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine