Provider Demographics
NPI:1437763224
Name:MOLA MEDICAL PRACTICE INC
Entity Type:Organization
Organization Name:MOLA MEDICAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLAZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-551-5490
Mailing Address - Street 1:6439 DEEP DELL PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2845
Mailing Address - Country:US
Mailing Address - Phone:718-551-5490
Mailing Address - Fax:
Practice Address - Street 1:6906 TREASURE TRL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1838
Practice Address - Country:US
Practice Address - Phone:718-551-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No282N00000XHospitalsGeneral Acute Care Hospital