Provider Demographics
NPI:1437293107
Name:WASIMA MASOODI MD INC
Entity Type:Organization
Organization Name:WASIMA MASOODI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WASIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-373-9980
Mailing Address - Street 1:23639 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5930
Mailing Address - Country:US
Mailing Address - Phone:310-373-9980
Mailing Address - Fax:310-373-5556
Practice Address - Street 1:23639 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5930
Practice Address - Country:US
Practice Address - Phone:310-373-9980
Practice Address - Fax:310-373-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWA70496A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH78371Medicare UPIN
CAWA70496AMedicare ID - Type Unspecified