Healthcare Provider Details

I. General information

NPI: 1568043156
Provider Name (Legal Business Name): DANIEL MOSALLAEI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7968
  • Fax: 760-773-1528
Mailing address:
  • Phone: 760-834-7968
  • Fax: 760-773-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA188209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: