Provider Demographics
NPI:1134291032
Name:MOOSSAZADEH, FARSHID (MD)
Entity type:Individual
Prefix:
First Name:FARSHID
Middle Name:
Last Name:MOOSSAZADEH
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 1:11633 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2321
Mailing Address - Country:US
Mailing Address - Phone:310-355-1950
Mailing Address - Fax:310-355-1957
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2324
Practice Address - Country:US
Practice Address - Phone:310-355-1950
Practice Address - Fax:310-355-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG790110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G790110Medicaid
CA00G790110Medicaid