Provider Demographics
NPI:1871827345
Name:NATHWANI, NITYA ATUL (MD)
Entity Type:Individual
Prefix:DR
First Name:NITYA
Middle Name:ATUL
Last Name:NATHWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NITYA
Other - Middle Name:ATUL
Other - Last Name:NATHWANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-256-4673
Practice Address - Fax:626-301-8116
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 96527207RH0003X
CAA96527207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology