Provider Demographics
NPI:1245467273
Name:NURISTANI, ABDUL W (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:W
Last Name:NURISTANI
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:PO BOX 980934
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95798-0934
Mailing Address - Country:US
Mailing Address - Phone:916-500-4706
Mailing Address - Fax:916-200-4999
Practice Address - Street 1:2288 AUBURN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1619
Practice Address - Country:US
Practice Address - Phone:916-500-4706
Practice Address - Fax:916-200-4999
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 121191207R00000X
CAA121191207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194242313Medicaid
CAW18762OtherGROUP MEDICARE
CA1902846306OtherGROUP NPI