Provider Demographics
NPI:1346259538
Name:NASSIRI, MASSOUD (DC , QME)
Entity type:Individual
Prefix:DR
First Name:MASSOUD
Middle Name:
Last Name:NASSIRI
Suffix:
Gender:M
Credentials:DC , QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SARATOGA AVE
Mailing Address - Street 2:SUIT#215
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3403
Mailing Address - Country:US
Mailing Address - Phone:408-247-4401
Mailing Address - Fax:408-247-5006
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUIT#215
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3403
Practice Address - Country:US
Practice Address - Phone:408-247-4401
Practice Address - Fax:408-247-5006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14704111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0147041Medicare ID - Type Unspecified