Provider Demographics
NPI:1225269129
Name:MEHRABAN, MASOUD (MD)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:MEHRABAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MASOUD
Other - Middle Name:
Other - Last Name:HASSANI MEHRABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15464 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6149
Mailing Address - Country:US
Mailing Address - Phone:714-891-9008
Mailing Address - Fax:
Practice Address - Street 1:15464 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6149
Practice Address - Country:US
Practice Address - Phone:714-891-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine