Healthcare Provider Details

I. General information

NPI: 1235804857
Provider Name (Legal Business Name): ASSAL MOORI SHIR MOHAMMADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E PALOMAR ST
CHULA VISTA CA
91913-1800
US

IV. Provider business mailing address

1400 E PALOMAR ST
CHULA VISTA CA
91913-1800
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016510
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: