Provider Demographics
NPI:1669462115
Name:ASFAHA, NIGIST (MD)
Entity Type:Individual
Prefix:
First Name:NIGIST
Middle Name:
Last Name:ASFAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 N CURSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2806
Mailing Address - Country:US
Mailing Address - Phone:760-368-7712
Mailing Address - Fax:
Practice Address - Street 1:6601 WHITE FEATHER RD
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252
Practice Address - Country:US
Practice Address - Phone:760-366-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52081207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
009225T76Medicare ID - Type Unspecified
B95029Medicare UPIN