Provider Demographics
NPI:1225244155
Name:MOFID, MEHRDAD MARK (MD)
Entity Type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:MARK
Last Name:MOFID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9124
Mailing Address - Country:US
Mailing Address - Phone:858-909-9000
Mailing Address - Fax:858-909-9009
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:SUITE 300
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-909-9000
Practice Address - Fax:858-909-9009
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-01-04
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Provider Licenses
StateLicense IDTaxonomies
CAA83432208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A834320Medicaid
CA00A834320Medicaid
CAWA83432AMedicare PIN