Provider Demographics
NPI:1922073048
Name:HOWARD, NATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:S
Last Name:HOWARD
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 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:951-925-3606
Practice Address - Street 1:850 E LATHAM AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4391
Practice Address - Country:US
Practice Address - Phone:951-658-7205
Practice Address - Fax:951-766-1016
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11467027OtherCAQH
CAH64255Medicare UPIN
CA11467027OtherCAQH
CAH64255Medicare UPIN
CAZZZ01550ZMedicare ID - Type UnspecifiedMCR TEMECULA LOCATION