Healthcare Provider Details

I. General information

NPI: 1003127655
Provider Name (Legal Business Name): MOUSTAFA MOATAZ ABOSHADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 KATELLA AVE
LOS ALAMITOS CA
90720-3113
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY SUITE 500
LONG BEACH CA
90804
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-9603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02034
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128437
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA128437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: