Provider Demographics
NPI:1710381702
Name:CALIFORNIA HOME DOC
Entity Type:Organization
Organization Name:CALIFORNIA HOME DOC
Other - Org Name:CALIFORNIA HOME DOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELSALAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOGASBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-596-6278
Mailing Address - Street 1:4030 MOORPARK AVE
Mailing Address - Street 2:SUITE 251
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-4103
Mailing Address - Country:US
Mailing Address - Phone:408-596-6278
Mailing Address - Fax:
Practice Address - Street 1:4030 MOORPARK AVE
Practice Address - Street 2:SUITE 251
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-4103
Practice Address - Country:US
Practice Address - Phone:408-596-6278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193400000XOtherTAXONAMY