Healthcare Provider Details

I. General information

NPI: 1225269129
Provider Name (Legal Business Name): MASOUD MEHRABAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MASOUD HASSANI MEHRABAN

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

IV. Provider business mailing address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-9008
  • Fax:
Mailing address:
  • Phone: 714-891-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: