Provider Demographics
NPI:1710924097
Name:MOHAMMAD E RASSOULI MD, SC
Entity Type:Organization
Organization Name:MOHAMMAD E RASSOULI MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RASSOULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-716-4439
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-716-4439
Mailing Address - Fax:949-266-9719
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 165
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-716-4439
Practice Address - Fax:949-266-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA505872084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000073794Medicare PIN