Healthcare Provider Details

I. General information

NPI: 1780693572
Provider Name (Legal Business Name): MEHRAN REZA MOAREFI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MASOUD-REZA MOAREFI MD

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 SHERMAN WAY
WINNETKA CA
91306
US

IV. Provider business mailing address

20800 SHERMAN WAY
WINNETKA CA
91306
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-2273
  • Fax: 818-347-4257
Mailing address:
  • Phone: 818-883-2273
  • Fax: 818-347-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number232978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: