Provider Demographics
NPI:1003042342
Name:TABASSOMI, MOSTAFA (MD)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:TABASSOMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25716 HOLLY OAK CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-0739
Mailing Address - Country:US
Mailing Address - Phone:310-463-0987
Mailing Address - Fax:661-430-9020
Practice Address - Street 1:23838 VALENCIA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5319
Practice Address - Country:US
Practice Address - Phone:661-430-9030
Practice Address - Fax:661-430-9020
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106160207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB233097Medicare PIN