Provider Demographics
NPI:1912404831
Name:NABILI, PANAH (DPM)
Entity Type:Individual
Prefix:
First Name:PANAH
Middle Name:
Last Name:NABILI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 N 1ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5470
Mailing Address - Country:US
Mailing Address - Phone:559-436-8262
Mailing Address - Fax:559-627-9772
Practice Address - Street 1:6061 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5470
Practice Address - Country:US
Practice Address - Phone:559-436-8262
Practice Address - Fax:559-627-9772
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005857213ES0103X
390200000X
CA5782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program