Provider Demographics
NPI:1144455262
Name:AL NAHLAWI, BASMA (MD)
Entity type:Individual
Prefix:DR
First Name:BASMA
Middle Name:
Last Name:AL NAHLAWI
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:PO BOX 511475
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-8030
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:800-334-1041
Practice Address - Street 1:960 W SAN MARCOS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1147
Practice Address - Country:US
Practice Address - Phone:760-707-6765
Practice Address - Fax:760-736-8092
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115924207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB257814OtherMEDICARE PTAN
CACB220217Medicare PIN
CACB220216Medicare PIN