Healthcare Provider Details

I. General information

NPI: 1962526756
Provider Name (Legal Business Name): ADEL MOSTAFAVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S GRAND AVE STE 475
LOS ANGELES CA
90017-4622
US

IV. Provider business mailing address

13701 RIVERSIDE DR SUITE 606
SHERMAN OAKS CA
91423-2430
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-0670
  • Fax:
Mailing address:
  • Phone: 310-871-0670
  • Fax: 310-469-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA92472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: