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General NPI Number Information
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NPI Number | 1578853800
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Entity Type | Organization
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Legal Business Name | ONE SOURCE HEALING, INC.
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 7365 CARNELIAN ST STE 204
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1157
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Country | US
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Telephone | 909-989-0808
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Fax | 909-989-6622
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Provider Business Mailing Address
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Address Line | 7365 CARNELIAN ST STE 204
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1157
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Country | US
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Telephone | 909-989-0808
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Fax | 909-989-6622
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. MOSES NASSER
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Credential | D.O.
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Telephone | 909-989-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A9301
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License Number State | CA
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