Provider Demographics
NPI:1659364271
Name:NASR, HAFEZ ALI (MD)
Entity type:Individual
Prefix:DR
First Name:HAFEZ
Middle Name:ALI
Last Name:NASR
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 1:1515 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7092
Mailing Address - Country:US
Mailing Address - Phone:805-737-8700
Mailing Address - Fax:
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:805-737-8700
Practice Address - Fax:780-573-8701
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC156000207Q00000X
IL036103601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine