=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265726707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH COUNTY NEONATOLOGY SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 06/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4002 VISTA WAY
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92056-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-940-3386
-----------------------------------------------------
Fax | 760-940-7770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4536
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92052-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-940-3386
-----------------------------------------------------
Fax | 760-940-7770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HAMID R MOVAHHEDIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 760-940-3386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | A49253
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | A49253
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------