Provider Demographics
NPI:1912918905
Name:SAFIE, NERISSA C (MD)
Entity Type:Individual
Prefix:
First Name:NERISSA
Middle Name:C
Last Name:SAFIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25485 MEDICAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6927
Mailing Address - Country:US
Mailing Address - Phone:951-894-4436
Mailing Address - Fax:951-677-8080
Practice Address - Street 1:25485 MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6927
Practice Address - Country:US
Practice Address - Phone:951-894-4436
Practice Address - Fax:951-677-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A778060Medicare ID - Type Unspecified