Healthcare Provider Details

I. General information

NPI: 1265726707
Provider Name (Legal Business Name): NORTH COUNTY NEONATOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

IV. Provider business mailing address

PO BOX 4536
OCEANSIDE CA
92052-4536
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-3386
  • Fax: 760-940-7770
Mailing address:
  • Phone: 760-940-3386
  • Fax: 760-940-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA49253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA49253
License Number StateCA

VIII. Authorized Official

Name: HAMID R MOVAHHEDIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-940-3386