Healthcare Provider Details

I. General information

NPI: 1629685730
Provider Name (Legal Business Name): FARSHID MOOSSAZADEH M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 HAWTHORNE BLVD STE 300
HAWTHORNE CA
90250-2369
US

IV. Provider business mailing address

11633 HAWTHORNE BLVD STE 300
HAWTHORNE CA
90250-2369
US

V. Phone/Fax

Practice location:
  • Phone: 310-355-1950
  • Fax: 310-355-1957
Mailing address:
  • Phone: 310-355-1950
  • Fax: 310-355-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARSHID MOOSSAZADEH
Title or Position: PRESIDENT
Credential: MD
Phone: 310-355-1950