Healthcare Provider Details

I. General information

NPI: 1215295662
Provider Name (Legal Business Name): DANIEL MAYER POURSHALIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 03/07/2023
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAWTELLE BLVD STE 130
LOS ANGELES CA
90025-7072
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-996-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number307532
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number298144
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number298144
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: