1790701886 NPI number — NADRA MONICA SAAD M.D.

Table of content: (NPI 1043428881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790701886 NPI number — NADRA MONICA SAAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAAD
Provider First Name:
NADRA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAAD
Provider Other First Name:
MONICA
Provider Other Middle Name:
NADRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790701886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLING HILLS ESTATES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90274-9552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-544-6858
Provider Business Mailing Address Fax Number:
310-544-6855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 DEEP VALLEY DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ROLLING HILLS ESTATES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90274-7605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-544-6858
Provider Business Practice Location Address Fax Number:
310-544-6855
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  C42961 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: WC42961C . This is a "PPIN" identifier . This identifiers is of the category "OTHER".




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