Healthcare Provider Details

I. General information

NPI: 1366381592
Provider Name (Legal Business Name): DANIEL MOKHTAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-5656
  • Fax:
Mailing address:
  • Phone: 747-210-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: