Basic Information
| Provider Information | |||||||||
| NPI: | 1508912494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHWEIRI | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LESA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1649 TERMINO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908042120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624347777 | ||||||||
| FaxNumber: | 5624333737 | ||||||||
| Practice Location | |||||||||
| Address1: | 5977 E SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908083752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624213727 | ||||||||
| FaxNumber: | 5624208948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A65518 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A65518 | 01 | CA | STATE LICENSE | OTHER |