Provider Demographics
NPI:1982697694
Name:LARRY NESTOR MD INC
Entity Type:Organization
Organization Name:LARRY NESTOR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-7935
Mailing Address - Street 1:1750 W CAMERON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2723
Mailing Address - Country:US
Mailing Address - Phone:626-960-3061
Mailing Address - Fax:
Practice Address - Street 1:1750 W CAMERON AVE
Practice Address - Street 2:STE 100
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2723
Practice Address - Country:US
Practice Address - Phone:626-960-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG264962080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G264961Medicare UPIN