Healthcare Provider Details

I. General information

NPI: 1649733940
Provider Name (Legal Business Name): PEGAH MIRHOSSEINI, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9436 SLAUSON AVE
PICO RIVERA CA
90660-4748
US

IV. Provider business mailing address

6255 E 6TH ST
LONG BEACH CA
90803-2117
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-3284
  • Fax:
Mailing address:
  • Phone: 562-221-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGAH MIRHOSSEINI
Title or Position: PRESIDENT
Credential: MD
Phone: 562-221-6680