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General NPI Number Information
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NPI Number | 1184005696
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Entity Type | Individual
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Provider Name | PHILICIA MOONSAMY MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 310-423-2640
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Fax | 310-967-0669
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | L-264059
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | A196043
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License Number State | CA
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