Healthcare Provider Details

I. General information

NPI: 1154308062
Provider Name (Legal Business Name): MOSE ARDITI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
LOS ANGELES CA
90048-1865
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6310
  • Fax: 310-423-8284
Mailing address:
  • Phone: 310-423-4471
  • Fax: 310-423-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA479151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA149151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: