Healthcare Provider Details

I. General information

NPI: 1275563017
Provider Name (Legal Business Name): WASIMA MASOODI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23639 HAWTHORNE BLVD SUITE 102
TORRANCE CA
90505-5930
US

IV. Provider business mailing address

23639 HAWTHORNE BLVD SUITE 102
TORRANCE CA
90505-5930
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-9980
  • Fax: 310-373-5556
Mailing address:
  • Phone: 310-373-9980
  • Fax: 310-373-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA70496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: