Provider Demographics
NPI:1396376141
Name:SADI, MOSES MOUSSA SIMBI
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:MOUSSA SIMBI
Last Name:SADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 LILA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3579
Mailing Address - Country:US
Mailing Address - Phone:904-485-3994
Mailing Address - Fax:
Practice Address - Street 1:1183 LILA ST APT 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3579
Practice Address - Country:US
Practice Address - Phone:904-485-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver