MEDICARE: ROMINA MOGTADERI MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487384798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMINA MOGTADERI MSW

Provider Business Mailing Address
First Line	:	12095 WEST WASHINGTON BOULEVARD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066
Country	:	US
Telephone Number	:	818-781-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	12095 WEST WASHINGTON BOULEVARD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90066-8520
Country	:	US
Telephone Number	:	818-781-0360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/26/2023

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