Provider Demographics
NPI:1659585610
Name:MONA Z MOFID MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MONA Z MOFID MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:ZOHDI
Authorized Official - Last Name:MOFID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-412-3271
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1008
Mailing Address - Country:US
Mailing Address - Phone:858-412-3271
Mailing Address - Fax:858-412-3186
Practice Address - Street 1:8929 UNIVERSITY CENTER LN STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1008
Practice Address - Country:US
Practice Address - Phone:858-412-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83136207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19596Medicare ID - Type Unspecified
CAH71210Medicare UPIN