Healthcare Provider Details

I. General information

NPI: 1336186253
Provider Name (Legal Business Name): NEDA MOATAMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE STE 13-145D
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W. CENTURY BLVD #400
LOS ANGELES CA
90045-5655
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9288
  • Fax: 310-267-2058
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA76414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA76414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: