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General NPI Number Information
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NPI Number | 1649733940
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Entity Type | Organization
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Legal Business Name | PEGAH MIRHOSSEINI, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 9436 SLAUSON AVE
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City | PICO RIVERA
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State | CA
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Zip | 90660-4748
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Country | US
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Telephone | 562-942-3284
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Fax |
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Provider Business Mailing Address
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Address Line | 6255 E 6TH ST
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City | LONG BEACH
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State | CA
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Zip | 90803-2117
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Country | US
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Telephone | 562-221-6680
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PEGAH MIRHOSSEINI
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Credential | MD
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Telephone | 562-221-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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