Provider Demographics
NPI:1265626329
Name:GEBRI, NASHWA NOEL
Entity type:Individual
Prefix:DR
First Name:NASHWA
Middle Name:NOEL
Last Name:GEBRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 JAMACHA RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3662
Mailing Address - Country:US
Mailing Address - Phone:800-417-4444
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:4060 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1608
Practice Address - Country:US
Practice Address - Phone:619-328-1335
Practice Address - Fax:619-328-1336
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55696Medicaid