Provider Demographics
NPI:1376350298
Name:KASSA, NATHANAEL ADMAS
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:ADMAS
Last Name:KASSA
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 1:6517 REAMER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-6809
Mailing Address - Country:US
Mailing Address - Phone:346-932-2821
Mailing Address - Fax:
Practice Address - Street 1:6517 REAMER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-6809
Practice Address - Country:US
Practice Address - Phone:346-932-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22934701172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver