Provider Demographics
NPI:1396259172
Name:NADI, MASOUD (FNP-C)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:NADI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0701
Mailing Address - Country:US
Mailing Address - Phone:619-609-9294
Mailing Address - Fax:619-720-2112
Practice Address - Street 1:4535 70TH ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0701
Practice Address - Country:US
Practice Address - Phone:619-609-9294
Practice Address - Fax:619-720-2112
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily