Provider Demographics
NPI:1710101811
Name:E NADJMABADI, INC.
Entity Type:Organization
Organization Name:E NADJMABADI, INC.
Other - Org Name:ESMAIL NADJMABADI MD, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NADJMABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-301-7519
Mailing Address - Street 1:300 OLD RIVER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9512
Mailing Address - Country:US
Mailing Address - Phone:661-301-7519
Mailing Address - Fax:661-491-3459
Practice Address - Street 1:300 OLD RIVER RD STE 150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9512
Practice Address - Country:US
Practice Address - Phone:661-301-7519
Practice Address - Fax:661-491-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56456207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1017416OtherCLIA
CAZZZ28685ZMedicaid
CAP00013085OtherMEDICARE RAILROAD
CADB6727OtherMEDICARE RAILROAD
CAG84428Medicare UPIN
CA00A564560Medicare PIN
CAP00013085OtherMEDICARE RAILROAD