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General NPI Number Information
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NPI Number | 1568616027
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Entity Type | Individual
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Provider Name | RAMY MOHARRAM PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 2121 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2303
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Country | US
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Telephone | 310-829-8618
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Fax | 310-829-8607
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Provider Business Mailing Address
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Address Line | 17212 N SCOTTSDALE RD #3019
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-9615
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Country | US
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Telephone | 301-807-9785
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4287
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 21491
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License Number State | CA
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