Provider Demographics
NPI:1457806473
Name:NASREDDINE, ZIAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:NASREDDINE
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 1:17350 W SUNSET BLVD APT 202C
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4104
Mailing Address - Country:US
Mailing Address - Phone:514-916-2663
Mailing Address - Fax:
Practice Address - Street 1:4896 TASCHEREAU SUITE 250
Practice Address - Street 2:
Practice Address - City:GREENFIELD PARK
Practice Address - State:QUEBEC
Practice Address - Zip Code:J4V 2J2
Practice Address - Country:CA
Practice Address - Phone:450-672-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG081754261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG081754OtherCALIFORNIA MEDICAL LICENSE