Healthcare Provider Details

I. General information

NPI: 1093327611
Provider Name (Legal Business Name): ADEL MOSTAFAVI, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 40TH ST RM 400
NEW YORK NY
10018-3692
US

IV. Provider business mailing address

801 S GRAND AVE STE 475
LOS ANGELES CA
90017-4622
US

V. Phone/Fax

Practice location:
  • Phone: 646-661-2227
  • Fax:
Mailing address:
  • Phone: 949-400-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEL MOSTAFAVI
Title or Position: CEO
Credential: MD
Phone: 310-871-0670