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NPI Code Detail

MEDICARE: NAFISEH MOGHADAM P.A.

MEDICARE: NAFISEH MOGHADAM P.A.
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
1363A00000XPhysician AssistantPA17768CA

General Provider Information

NPI Number : 1922023084
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAFISEH MOGHADAM P.A.
Provider Business Mailing Address
First Line : PO BOX 115
Second Line :
City : S PASADENA
State : CA
Zip : 91031-0115
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8405 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-3401
Country : US
Telephone Number : 323-385-3005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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