Provider Demographics
NPI:1851861827
Name:NASSRI, DERA
Entity Type:Individual
Prefix:
First Name:DERA
Middle Name:
Last Name:NASSRI
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 1:16804 FALCON SOUND DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8386
Mailing Address - Country:US
Mailing Address - Phone:225-335-1284
Mailing Address - Fax:
Practice Address - Street 1:16804 FALCON SOUND DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-8386
Practice Address - Country:US
Practice Address - Phone:225-335-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator