Individual provider Active NPI

Moses S Nasser Jr., D.O.

  • Addiction Medicine (Family Medicine) Physician
  • Glendora, CA
National Provider Identifier
1902023682
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
20A9301 Issued in CA
Practice address
1146 E Route 66
Glendora, CA 91740-3773
Phone
(909) 206-4188
NPI assigned
Apr 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X 20A9301 CA Primary

Addresses

Primary practice location

1146 E Route 66
Glendora, CA 91740-3773

Mailing address

1146 E Route 66
Glendora, CA 91740-3773
Phone (909) 206-4188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060223000844 CA Practitioner - Internal Medicine 5294741534 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A9301CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KND Development 59, LLC CurrentSince Nov 14, 2012 Accepting new patients
KND Development 59 LLC CurrentSince Nov 14, 2012 Accepting new patients
Pinnacle Medical Group, Inc Family Medicine CurrentSince Feb 5, 2016 Accepting new patients
Pinnacle Medical Group, Inc Family Medicine CurrentSince Feb 5, 2016 Accepting new patients
KND Development 59 LLC Current Accepting new patients
Glendora Recovery Center Past Accepting new patients
Moses S. Nasser Jr., DO, Inc. Addiction Medicine Past Accepting new patients
LH Blue Sky Inc Past Accepting new patients

Locations

10841 White Oak Ave
Rch Cucamonga, CA 91730
Phone (626) 914-1514

10431 Lemon Ave
Ste N
Rch Cucamonga, CA 91737
Phone (909) 466-6579

10841 White Oak Ave
Ste 103
Rch Cucamonga, CA 91730
Phone (909) 297-2128

1851 N Riverside Ave
Rialto, CA 92376
Phone (909) 421-2700

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1902023682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1146 E ROUTE 66",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917403773",
            "telephone_number": "909-206-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 E ROUTE 66",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917403773",
            "telephone_number": "909-206-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASSER",
        "first_name": "MOSES",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "20A9301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.