MEDICARE: COSMOPOLITAN MEDICAL SPA INC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1730821935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMOPOLITAN MEDICAL SPA INC

Provider Business Mailing Address
First Line	:	6125 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4503
Country	:	US
Telephone Number	:	323-723-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4503
Country	:	US
Telephone Number	:	323-723-5656
Fax Number	:

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	MEELAD MOHAMMADI
Credential	:	M.D
Telephone Number	:	323-674-7778

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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