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General NPI Number Information
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NPI Number | 1841696283
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Entity Type | Organization
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Legal Business Name | FM MEDICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 1400 QUAIL ST SUITE 150
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2730
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Country | US
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Telephone | 949-306-1663
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Fax |
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Provider Business Mailing Address
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Address Line | 25108 MARGUERITE PKWY SUITE A203
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City | MISSION VIEJO
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State | CA
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Zip | 92692-2400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARZIN MOHTADI
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Credential | DO
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Telephone | 949-306-1663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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