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General NPI Number Information
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NPI Number | 1891115622
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE BARIATRICS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/19/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E SUITE 1508
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City | LOS ANGELES
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State | CA
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Zip | 90067-2001
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Country | US
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Telephone | 310-694-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 BROCKTON AVE APT 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1390
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Country | US
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Telephone | 443-831-2561
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BABAK MOEINOLMOLKI
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Credential | MD
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Telephone | 443-831-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A92803
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License Number State | CA
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