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General NPI Number Information
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NPI Number | 1255521878
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Entity Type | Organization
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Legal Business Name | MEDICAL BODY CONCEPTS, PC.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 26712 SIERRA VIS
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City | MISSION VIEJO
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State | CA
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Zip | 92692-3338
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Country | US
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Telephone | 949-582-7690
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Fax |
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Provider Business Mailing Address
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Address Line | 26712 SIERRA VIS
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City | MISSION VIEJO
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State | CA
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Zip | 92692-3338
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Country | US
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Telephone | 949-582-7690
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. FARZIN MOHTADI
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Credential | D.O.
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Telephone | 949-306-1663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A9219
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License Number State | CA
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