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General NPI Number Information
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NPI Number | 1851448757
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Entity Type | Organization
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Legal Business Name | MOTHERS AND DAUGHTERS CENTER, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 720 PAULARINO AVENUE SUITE 240
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City | COSTA MESA
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State | CA
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Zip | 92626-6290
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Country | US
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Telephone | 714-547-7575
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Fax | 714-547-8881
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Provider Business Mailing Address
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Address Line | 720 PAULARINO AVENUE SUITE 240
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City | COSTA MESA
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State | CA
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Zip | 92626-6290
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Country | US
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Telephone | 714-547-7575
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Fax | 714-547-8881
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHY MIRZABOZORG ANDERSON
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Credential | MD
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Telephone | 714-547-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G78317
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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