Provider Demographics
NPI:1881851574
Name:NABIL KOUDSI MD INC
Entity Type:Organization
Organization Name:NABIL KOUDSI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUDSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-3411
Mailing Address - Street 1:811 EAST 11TH ST #207
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-981-3411
Mailing Address - Fax:909-946-7740
Practice Address - Street 1:811 EAST 11TH ST #207
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-981-3411
Practice Address - Fax:909-946-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337970Medicaid
CA00A337970Medicare PIN
CA00A337970Medicaid