Healthcare Provider Details

I. General information

NPI: 1043497472
Provider Name (Legal Business Name): MOBASHSHERA JABEEN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15730 PARAMOUNT BLVD CONSULTARIO MEDICO LATINO MEDICAL CENTER
PARAMOUNT CA
90723-4333
US

IV. Provider business mailing address

1431 257TH ST APT.#3
HARBOR CITY CA
90710-2753
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-1000
  • Fax:
Mailing address:
  • Phone: 562-634-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number19427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: