Provider Demographics
NPI:1558845792
Name:TABIBIAN, MOJDEH (PA)
Entity Type:Individual
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First Name:MOJDEH
Middle Name:
Last Name:TABIBIAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 404
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4016
Mailing Address - Country:US
Mailing Address - Phone:818-592-6005
Mailing Address - Fax:818-592-6088
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 404
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4016
Practice Address - Country:US
Practice Address - Phone:818-592-6005
Practice Address - Fax:818-592-6088
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA56021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant