Healthcare Provider Details

I. General information

NPI: 1225501133
Provider Name (Legal Business Name): MOKABBERI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 400
ORANGE CA
92868-4226
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 400
ORANGE CA
92868-4226
US

V. Phone/Fax

Practice location:
  • Phone: 949-774-7777
  • Fax: 714-543-8553
Mailing address:
  • Phone: 949-774-7777
  • Fax: 714-543-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RASOUL MOKABBERI
Title or Position: PRESIDENT
Credential: MD
Phone: 949-436-3773