Healthcare Provider Details

I. General information

NPI: 1114197589
Provider Name (Legal Business Name): SHEILA S NAZARIAN MOBIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2008
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 WILSHIRE BLVD #1903
LOS ANGELES CA
90024-4634
US

IV. Provider business mailing address

120 S. SPALDING DR #315
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-621-1326
  • Fax:
Mailing address:
  • Phone: 310-659-0500
  • Fax: 310-388-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA97647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: