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General NPI Number Information
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NPI Number | 1376043513
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Entity Type | Organization
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Legal Business Name | B MOUSSAZADEH A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 5620 WILBUR AVE STE 305
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City | TARZANA
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State | CA
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Zip | 91356-1311
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Country | US
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Telephone | 818-588-4741
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Fax | 818-588-4748
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Provider Business Mailing Address
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Address Line | 5620 WILBUR AVE STE 305
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City | TARZANA
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State | CA
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Zip | 91356-1311
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Country | US
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Telephone | 818-588-4741
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Fax | 818-588-4748
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHEYENNE KAIPAT
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Credential |
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Telephone | 818-588-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A108651
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License Number State | CA
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