Provider Demographics
NPI:1942961644
Name:NASSAR, KHOLOUD ALI (CCP)
Entity Type:Individual
Prefix:
First Name:KHOLOUD
Middle Name:ALI
Last Name:NASSAR
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-558-4354
Mailing Address - Fax:909-558-0348
Practice Address - Street 1:11175 CAMPUS ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-558-4354
Practice Address - Fax:909-558-0348
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist