Healthcare Provider Details

I. General information

NPI: 1285654772
Provider Name (Legal Business Name): HAMID MORADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD SUITE 210
RESEDA CA
91335-6308
US

IV. Provider business mailing address

19231 VICTORY BLVD SUITE 210
RESEDA CA
91335-6308
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-8210
  • Fax: 818-881-1710
Mailing address:
  • Phone: 818-881-8210
  • Fax: 818-881-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA66448
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierA66448
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: