Individual provider Active NPI

Dena Rafiq Nasir, MD

  • Colon & Rectal Surgery Physician
  • Glendale, CA
National Provider Identifier
1083272819
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
A182239 Issued in CA
Practice address
222 W Eulalia St
Glendale, CA 91204-2849
Phone
(818) 730-3726
NPI assigned
Jun 5, 2019
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X A182239 CA Primary

Addresses

Primary practice location

222 W Eulalia St
Glendale, CA 91204-2849

Mailing address

4133 Via Marina Apt 211
Marina del Rey, CA 90292-5360
Phone (818) 730-3726

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250827003094 CA Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 6709262637 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
Oakland Univ, William Beaumont School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Petar Vukasin M D IncGroup PAC ID 3577732072, 3 clinicians

Practice addresses (Care Compare)

106 Lynch Creek Way
Suite 9B
Petaluma, CA 94954-2356
Phone (707) 763-1575

222 W Eulalia St
Suite 100a
Glendale, CA 91204-2850
Phone (818) 244-8161

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A182239CAMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Feb 26, 2026 Accepting new patients
Petar Vukasin M D Inc Colon & Rectal Surgery CurrentSince Sep 2, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Feb 26, 2026 Accepting new patients

Locations

222 W Eulalia St
Ste 100A
Glendale, CA 91204
Phone (818) 244-8161

106 Lynch Creek Way
Ste 9B
Petaluma, CA 94954
Phone (707) 763-1575

1162 Montgomery Dr
Ste 300
Santa Rosa, CA 95405
Phone (707) 547-5437

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1083272819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 VIA MARINA APT 211",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925360",
            "telephone_number": "818-730-3726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W EULALIA ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042849",
            "telephone_number": "818-730-3726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASIR",
        "first_name": "DENA",
        "middle_name": "RAFIQ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "A182239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.