MEDICARE: MR. REY MOOSAVI M.D.

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	208D00000X	General Practice Physician	A35706	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801972716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REY MOOSAVI M.D.

Provider Business Mailing Address
First Line	:	1333 E MAIN ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-6540
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

Provider Business Practice Location Address
First Line	:	1333 E MAIN ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-6540
Country	:	US
Telephone Number	:	619-447-6001
Fax Number	:	619-447-6096

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	04/28/2015

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