Provider Demographics
NPI:1770313652
Name:NASR, MOHAMAD
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:NASR
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 1:2342 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1517
Mailing Address - Country:US
Mailing Address - Phone:656-503-7959
Mailing Address - Fax:
Practice Address - Street 1:394 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1749
Practice Address - Country:US
Practice Address - Phone:650-379-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL020749343800000X
CABL-020749343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)