Healthcare Provider Details

I. General information

NPI: 1063977049
Provider Name (Legal Business Name): MINOO MAHMOUDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 425
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 425
BEVERLY HILLS CA
90211-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-746-4395
  • Fax: 310-432-7065
Mailing address:
  • Phone: 310-746-4395
  • Fax: 310-432-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC160570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: