Provider Demographics
NPI:1487096145
Name:NASTA MEDICAL CORPORATION
Entity type:Organization
Organization Name:NASTA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARTI
Authorized Official - Middle Name:M
Authorized Official - Last Name:NASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-701-1882
Mailing Address - Street 1:415 TESCONI CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4619
Mailing Address - Country:US
Mailing Address - Phone:707-578-1175
Mailing Address - Fax:707-578-1147
Practice Address - Street 1:401 WARREN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1578
Practice Address - Country:US
Practice Address - Phone:650-701-1882
Practice Address - Fax:650-701-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty