Provider Demographics
NPI:1669835906
Name:NIMERI, YUSSRA
Entity Type:Individual
Prefix:
First Name:YUSSRA
Middle Name:
Last Name:NIMERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S BASCOM AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3543
Mailing Address - Country:US
Mailing Address - Phone:619-550-6368
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:1210 S BASCOM AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3543
Practice Address - Country:US
Practice Address - Phone:619-550-6368
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21752103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst