1609953603 NPI number — NAGUI NABIL SOROUR MD

Table of content: NAGUI NABIL SOROUR MD (NPI 1609953603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609953603 NPI number — NAGUI NABIL SOROUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOROUR
Provider First Name:
NAGUI
Provider Middle Name:
NABIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609953603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 S FAIRMONT AVE #100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-334-2010
Provider Business Mailing Address Fax Number:
209-334-0132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 S FAIRMONT AVE #100
Provider Second Line Business Practice Location Address:
LODI
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-334-2010
Provider Business Practice Location Address Fax Number:
209-334-0132
Provider Enumeration Date:
11/01/2006

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: 2086S0129X , with the licence number:  A312100 , 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: 0200005210 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 942658928 . This is a "COMMERICAL INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A312100 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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