Healthcare Provider Details

I. General information

NPI: 1912908369
Provider Name (Legal Business Name): DARUSH LAWRENCE MOHYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

7724 FAY AVE
LA JOLLA CA
92037-4309
US

IV. Provider business mailing address

7724 FAY AVE
LA JOLLA CA
92037-4309
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-2700
  • Fax: 858-454-2782
Mailing address:
  • Phone: 858-454-2700
  • Fax: 858-454-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA055635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: