Provider Demographics
NPI:1023061314
Name:MANI, NASRIN (MD)
Entity type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 FAY AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4309
Mailing Address - Country:US
Mailing Address - Phone:619-587-8035
Mailing Address - Fax:858-454-2782
Practice Address - Street 1:7720 FAY AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4309
Practice Address - Country:US
Practice Address - Phone:858-454-2700
Practice Address - Fax:858-454-2782
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40473174400000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE79786Medicare UPIN
CAEW414ZMedicare PIN