N/a | |
11633 Hawthorne Blvd Ste 300 Hawthorne CA 90250-2369 | |
(310) 355-1950 | |
(310) 355-1957 |
Full Name | N/a |
---|---|
Speciality | Family Medicine |
Location | 11633 Hawthorne Blvd Ste 300, Hawthorne, California |
Authorized Official Name and Position | Farshid Moossazadeh (PRESIDENT) |
Authorized Official Contact | 3103551950 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
N/a 11633 Hawthorne Blvd Ste 300 Hawthorne CA 90250-2369 Ph: (310) 355-1950 | N/a 11633 Hawthorne Blvd Ste 300 Hawthorne CA 90250-2369 Ph: (310) 355-1950 |
NPI Number | 1629685730 |
---|---|
Provider Enumeration Date | 09/23/2020 |
Last Update Date | 09/09/2021 |
Medicare PECOS PAC ID | 3173941994 |
---|---|
Medicare Enrollment ID | O20200910002620 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629685730 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
Provider Name | Farshid Moossazadeh |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1134291032 PECOS PAC ID: 6800109265 Enrollment ID: I20150715000408 |
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