Healthcare Provider Details

I. General information

NPI: 1750777553
Provider Name (Legal Business Name): POURIA MOSHAYEDI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 07/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 WESTWOOD PLAZA, RM 1-240 ATTN: POURIA MOSHAYEDI, NEUROLOGY EDUCATION OFFICE
LOS ANGELES CA
90095-8353
US

IV. Provider business mailing address

710 WESTWOOD PLAZA, RM 1-240 ATTN: POURIA MOSHAYEDI, NEUROLOGY EDUCATION OFFICE
LOS ANGELES CA
90095-8353
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6681
  • Fax: 310-206-4733
Mailing address:
  • Phone: 310-825-6681
  • Fax: 310-206-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: