Provider Demographics
NPI:1770856817
Name:NASTRO, JOHN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:NASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3218
Mailing Address - Country:US
Mailing Address - Phone:310-927-7132
Mailing Address - Fax:910-776-7479
Practice Address - Street 1:945 MANNING AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3218
Practice Address - Country:US
Practice Address - Phone:310-927-7132
Practice Address - Fax:910-776-7479
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20705207R00000X
CAG207050207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A89336Medicare UPIN