Healthcare Provider Details

I. General information

NPI: 1003996844
Provider Name (Legal Business Name): MOHSEN M HAMZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 WILSHIRE BLVD SUITE # 420
LOS ANGELES CA
90025-5781
US

IV. Provider business mailing address

11600 WILSHIRE BLVD SUITE # 420
LOS ANGELES CA
90025-5781
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-7201
  • Fax:
Mailing address:
  • Phone: 310-477-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA43543
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA43543
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA43543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: