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General NPI Number Information
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NPI Number | 1356967699
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Entity Type | Organization
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Legal Business Name | MOHSEN TAVOUSSI, D.O. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 9209 COLIMA RD STE 2300
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City | WHITTIER
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State | CA
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Zip | 90605-1817
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Country | US
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Telephone | 866-503-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 210 MONARCH BAY DR
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City | DANA POINT
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State | CA
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Zip | 92629-3438
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Country | US
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Telephone | 714-608-4106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHSEN TAVOUSSI
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Credential | D.O.
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Telephone | 714-608-4106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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