Provider Demographics
NPI:1093973760
Name:TABRIZI, MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:TABRIZI
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 1:3300 E SOUTH ST #103
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:562-634-9803
Mailing Address - Fax:562-634-0335
Practice Address - Street 1:3300 E SOUTH STREET
Practice Address - Street 2:SUITE # 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-634-9803
Practice Address - Fax:562-634-0335
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108941207RE0101X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29034248Medicaid
NM417225YL09Medicare PIN