Provider Demographics
NPI:1891386876
Name:MOUSSA, GHADIR A
Entity type:Individual
Prefix:
First Name:GHADIR
Middle Name:A
Last Name:MOUSSA
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 1:23917 ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1628
Mailing Address - Country:US
Mailing Address - Phone:313-268-4908
Mailing Address - Fax:
Practice Address - Street 1:23917 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1628
Practice Address - Country:US
Practice Address - Phone:313-268-4908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist