Provider Demographics
NPI:1497564850
Name:LASSISSI, MOHAMMED HALID
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:HALID
Last Name:LASSISSI
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 1:9164 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4059
Mailing Address - Country:US
Mailing Address - Phone:402-714-1606
Mailing Address - Fax:
Practice Address - Street 1:9164 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4059
Practice Address - Country:US
Practice Address - Phone:402-714-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider