Provider Demographics
NPI:1609101211
Name:MATLOOBI, MAHSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:MATLOOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 WORSHAM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1734
Mailing Address - Country:US
Mailing Address - Phone:562-430-4513
Mailing Address - Fax:844-684-7228
Practice Address - Street 1:3747 WORSHAM AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1734
Practice Address - Country:US
Practice Address - Phone:562-430-4513
Practice Address - Fax:844-684-7228
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-02242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM313433YR41OtherMEDICARE PTAN
NM89404530Medicaid