Healthcare Provider Details

I. General information

NPI: 1245560143
Provider Name (Legal Business Name): MORADI MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 PACIFIC BLVD
HUNTINGTON PARK CA
90255-5736
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 323-584-8222
  • Fax: 323-584-8606
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA92450
License Number StateCA

VIII. Authorized Official

Name: DR. NASSIM MORADI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243