Provider Demographics
NPI:1275613291
Name:DARUSH L. MOHYI, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DARUSH L. MOHYI, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:IVF LA JOLLA LA JOLLA COSMETIC VEIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-454-2700
Mailing Address - Street 1:7724 FAY AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4309
Mailing Address - Country:US
Mailing Address - Phone:858-454-2700
Mailing Address - Fax:858-454-2782
Practice Address - Street 1:7724 FAY AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4309
Practice Address - Country:US
Practice Address - Phone:858-454-2700
Practice Address - Fax:858-454-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275613291Medicaid
CA1275613291Medicaid