Healthcare Provider Details

I. General information

NPI: 1154615565
Provider Name (Legal Business Name): MORAD NASSERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MORAD NASSERI NOWSAR

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N WIGET LN
WALNUT CREEK CA
94598-2408
US

IV. Provider business mailing address

PO BOX 888584
LOS ANGELES CA
90088-8584
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-9806
  • Fax: 925-691-9807
Mailing address:
  • Phone: 925-691-9806
  • Fax: 925-691-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA172982
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA172982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: