Healthcare Provider Details

I. General information

NPI: 1902023682
Provider Name (Legal Business Name): MOSES S NASSER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 E ROUTE 66
GLENDORA CA
91740-3773
US

IV. Provider business mailing address

1146 E ROUTE 66
GLENDORA CA
91740-3773
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-4188
  • Fax:
Mailing address:
  • Phone: 909-206-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A9301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: