Provider Demographics
NPI:1699004044
Name:SHEIKH GUSTAVESON & NASSAR INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHEIKH GUSTAVESON & NASSAR INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAFAR
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-662-2700
Mailing Address - Street 1:1111 W 4TH ST
Mailing Address - Street 2:BLD B
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4474
Mailing Address - Country:US
Mailing Address - Phone:559-662-2700
Mailing Address - Fax:559-673-1588
Practice Address - Street 1:1111 W 4TH ST
Practice Address - Street 2:BLD B
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4474
Practice Address - Country:US
Practice Address - Phone:559-662-2700
Practice Address - Fax:559-673-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699004044Medicaid
CA1699004044Medicare PIN