MEDICARE: MAHMOOD MOSTOUFI MD

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	208000000X	Pediatrics Physician	A39664	CA

General Provider Information

NPI Number	:	1841365921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHMOOD MOSTOUFI MD

Provider Business Mailing Address
First Line	:	1125 E 17TH ST
Second Line	:	STE E 110
City	:	SANTA ANA
State	:	CA
Zip	:	92701-2214
Country	:	US
Telephone Number	:	714-550-0110
Fax Number	:	714-550-0737

Provider Business Practice Location Address
First Line	:	1125 E 17TH ST
Second Line	:	STE E 110
City	:	SANTA ANA
State	:	CA
Zip	:	92701-2214
Country	:	US
Telephone Number	:	714-550-0110
Fax Number	:	714-550-0737

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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