Provider Demographics
NPI:1487197323
Name:ALTOMEH, NASSIM TINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NASSIM
Middle Name:TINA
Last Name:ALTOMEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2011
Mailing Address - Country:US
Mailing Address - Phone:818-825-9493
Mailing Address - Fax:310-829-4375
Practice Address - Street 1:2505 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2011
Practice Address - Country:US
Practice Address - Phone:818-825-9493
Practice Address - Fax:310-829-4375
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist