Provider Demographics
NPI:1851448757
Name:MOTHERS AND DAUGHTERS CENTER, INC.
Entity Type:Organization
Organization Name:MOTHERS AND DAUGHTERS CENTER, INC.
Other - Org Name:MOTHERS AND DAUGHTERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MIRZABOZORG
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-7575
Mailing Address - Street 1:720 PAULARINO AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6290
Mailing Address - Country:US
Mailing Address - Phone:714-547-7575
Mailing Address - Fax:714-547-8881
Practice Address - Street 1:720 PAULARINO AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6290
Practice Address - Country:US
Practice Address - Phone:714-547-7575
Practice Address - Fax:714-547-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78317174400000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14517Medicare PIN