Provider Demographics
NPI:1629685730
Name:FARSHID MOOSSAZADEH, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARSHID MOOSSAZADEH, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSSAZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-355-1950
Mailing Address - Street 1:11633 HAWTHORNE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2369
Mailing Address - Country:US
Mailing Address - Phone:310-355-1950
Mailing Address - Fax:310-355-1957
Practice Address - Street 1:11633 HAWTHORNE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2369
Practice Address - Country:US
Practice Address - Phone:310-355-1950
Practice Address - Fax:310-355-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty