Provider Demographics
NPI:1003301573
Name:SHAMS A. MOUSAVILAR,MD,INC.
Entity Type:Organization
Organization Name:SHAMS A. MOUSAVILAR,MD,INC.
Other - Org Name:NEW VALLEY PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSAVILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-727-2150
Mailing Address - Street 1:1840 N HACIENDA BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1143
Mailing Address - Country:US
Mailing Address - Phone:626-727-2150
Mailing Address - Fax:
Practice Address - Street 1:1840 N HACIENDA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-727-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care