Provider Demographics
NPI:1154370302
Name:REDJAL, NASSER (MD)
Entity type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:REDJAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 CALLE PATRICIA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1939
Mailing Address - Country:US
Mailing Address - Phone:818-257-9732
Mailing Address - Fax:
Practice Address - Street 1:1523 CALLE PATRICIA
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-1939
Practice Address - Country:US
Practice Address - Phone:818-257-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41807207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50477Medicare UPIN
CAWA41807BMedicare PIN