Provider Demographics
NPI:1922652916
Name:EL-GHEZZAOUI, NADA
Entity type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:EL-GHEZZAOUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14632 SWEETAN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2428
Mailing Address - Country:US
Mailing Address - Phone:949-214-7640
Mailing Address - Fax:
Practice Address - Street 1:440 BROOME ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3569
Practice Address - Country:US
Practice Address - Phone:646-650-5337
Practice Address - Fax:646-871-6820
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030815363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty