Provider Demographics
NPI:1659197127
Name:NASH, AVI
Entity type:Individual
Prefix:MR
First Name:AVI
Middle Name:
Last Name:NASH
Suffix:
Gender:M
Credentials:
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 451
Mailing Address - Street 2:
Mailing Address - City:SIERRA BLANCA
Mailing Address - State:TX
Mailing Address - Zip Code:79851-0451
Mailing Address - Country:US
Mailing Address - Phone:830-282-7942
Mailing Address - Fax:
Practice Address - Street 1:1195 EL PASO ST # 451
Practice Address - Street 2:
Practice Address - City:SIERRA BLANCA
Practice Address - State:TX
Practice Address - Zip Code:79851-9800
Practice Address - Country:US
Practice Address - Phone:830-282-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory