Provider Demographics
NPI:1659600112
Name:EISA, NASEEM
Entity Type:Individual
Prefix:
First Name:NASEEM
Middle Name:
Last Name:EISA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10648 N DEARING AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-3405
Mailing Address - Country:US
Mailing Address - Phone:619-985-2457
Mailing Address - Fax:
Practice Address - Street 1:7230 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3340
Practice Address - Country:US
Practice Address - Phone:559-431-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.056919207R00000X
CAA137168207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine