Provider Demographics
NPI:1730124611
Name:NASSIF, TAREK R (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:R
Last Name:NASSIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:416 W LAS TUNAS DR
Mailing Address - Street 2:SUITE #307
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-289-0130
Mailing Address - Fax:626-289-0171
Practice Address - Street 1:416 W LAS TUNAS DR
Practice Address - Street 2:SUITE #307
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1236
Practice Address - Country:US
Practice Address - Phone:626-289-0130
Practice Address - Fax:626-289-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53919207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539190Medicaid
CAG23232Medicare UPIN
CAA53919Medicare ID - Type UnspecifiedMEDICARE