Healthcare Provider Details

I. General information

NPI: 1174434419
Provider Name (Legal Business Name): MAHSA SAFVATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 WILSHIRE BLVD STE 12
LOS ANGELES CA
90025-1588
US

IV. Provider business mailing address

11600 WILSHIRE BLVD STE 12
LOS ANGELES CA
90025-1588
US

V. Phone/Fax

Practice location:
  • Phone: 310-717-9081
  • Fax:
Mailing address:
  • Phone: 310-717-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number207RA0000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: