MEDICARE: LINDA MOGHTADER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0015X	Psychosomatic Medicine Physician	G56261	CA

General Provider Information

NPI Number	:	1497963722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MOGHTADER M.D.

Provider Business Mailing Address
First Line	:	12300 WILSHIRE BLVD
Second Line	:	SUITE 330
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12300 WILSHIRE BLVD
Second Line	:	SUITE 330
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1020
Country	:	US
Telephone Number	:	310-442-7601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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