Healthcare Provider Details

I. General information

NPI: 1861163008
Provider Name (Legal Business Name): MOIN SALAH MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROSECRANS AVE STE 202
MANHATTAN BEACH CA
90266-2470
US

IV. Provider business mailing address

1200 ROSECRANS AVE STE 202
MANHATTAN BEACH CA
90266-2470
US

V. Phone/Fax

Practice location:
  • Phone: 805-636-2905
  • Fax:
Mailing address:
  • Phone: 805-636-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOIN SALAH
Title or Position: CEO
Credential: MD, MBA
Phone: 805-636-2905