Healthcare Provider Details

I. General information

NPI: 1992631212
Provider Name (Legal Business Name): MOSES S. NASSER JR., DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 EAST ROUTE 66
GLENDORA CA
91740
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: 909-248-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MOSES NASSER JR.
Title or Position: CEO
Credential: DO
Phone: 909-438-1170