Healthcare Provider Details

I. General information

NPI: 1275129603
Provider Name (Legal Business Name): HOSSEIN MASOOMI, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW STE 300
LA JOLLA CA
92037-1417
US

IV. Provider business mailing address

4150 REGENTS PARK ROW STE 300
LA JOLLA CA
92037-1417
US

V. Phone/Fax

Practice location:
  • Phone: 858-909-9000
  • Fax: 858-909-9009
Mailing address:
  • Phone: 858-909-9000
  • Fax: 858-909-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HOSSEIN MASOOMI
Title or Position: OWNER / CEO
Credential: M.D.
Phone: 949-257-3143