Provider Demographics
NPI:1003230079
Name:MOUSAVI, BEN BEHROUZ (MD)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:BEHROUZ
Last Name:MOUSAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 MISSION CENTER CT STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1314
Mailing Address - Country:US
Mailing Address - Phone:818-625-7210
Mailing Address - Fax:
Practice Address - Street 1:7801 MISSION CENTER CT STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1314
Practice Address - Country:US
Practice Address - Phone:818-625-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CAA131983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital