Provider Demographics
NPI:1184741985
Name:BISHAI, NABIL F (MD)
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:F
Last Name:BISHAI
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 1:1850 N RIVERSIDE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8071
Mailing Address - Country:US
Mailing Address - Phone:909-421-3001
Mailing Address - Fax:909-421-3031
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-421-3001
Practice Address - Fax:909-421-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G374710Medicaid
CA180016068OtherRAILROAD MEDICARE ID#
CA00G374710Medicare ID - Type Unspecified
CA180016068OtherRAILROAD MEDICARE ID#