Healthcare Provider Details

I. General information

NPI: 1912292947
Provider Name (Legal Business Name): MOUSSAVI & TOVANYAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 RIVERSIDE DR STE 5
N HOLLYWOOD CA
91602-1066
US

IV. Provider business mailing address

11650 RIVERSIDE DR STE 5
N HOLLYWOOD CA
91602-1066
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-1221
  • Fax: 818-980-3221
Mailing address:
  • Phone: 818-980-1221
  • Fax: 818-980-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMYAR MOUSSAVI
Title or Position: CEO
Credential: DPM
Phone: 818-980-1221