Healthcare Provider Details

I. General information

NPI: 1699696377
Provider Name (Legal Business Name): MOBILE GERIATRICS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30700 RUSSELL RANCH RD STE 200
WESTLAKE VILLAGE CA
91362
US

IV. Provider business mailing address

30700 RUSSELL RANCH RD STE 200
WESTLAKE VILLAGE CA
91362
US

V. Phone/Fax

Practice location:
  • Phone: 310-943-7577
  • Fax: 310-943-7490
Mailing address:
  • Phone: 310-943-7577
  • Fax: 310-943-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAHZAD SHARABY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 310-943-7297