Physician Compare National (NPI:1285653196)

HEALTHCARE PROVIDER: MARYAM MORTEZAIEFARD D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1285653196
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315843471
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20031209001077
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MORTEZAIEFARD
	Individual professional last name
Provider First Name	MARYAM
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	OSTEOPATHIC MANIPULATIVE MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	21133 COSTANSO ST
	Group Practice or individual's line 1 address
City	WOODLAND HILLS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913642033
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y