Healthcare Provider Details

I. General information

NPI: 1669098091
Provider Name (Legal Business Name): NADEEM AYOUB ALI MOUSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N ACACIA AVE
REEDLEY CA
93654-2102
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-637-2384
  • Fax: 559-637-7550
Mailing address:
  • Phone: 559-353-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA184722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: