Provider Demographics
NPI:1134412240
Name:ADEL MOSTAFAVI MD, INC.
Entity type:Organization
Organization Name:ADEL MOSTAFAVI MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-371-0670
Mailing Address - Street 1:2042 LINDA FLORA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1407
Mailing Address - Country:US
Mailing Address - Phone:310-871-0670
Mailing Address - Fax:310-469-7845
Practice Address - Street 1:13701 RIVERSIDE DR
Practice Address - Street 2:STE 606
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2430
Practice Address - Country:US
Practice Address - Phone:310-871-0670
Practice Address - Fax:310-469-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA924722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000OtherN/A