Provider Demographics
NPI:1356670657
Name:MOBASSERI, POOYA (DO)
Entity type:Individual
Prefix:
First Name:POOYA
Middle Name:
Last Name:MOBASSERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 E THOUSAND OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5925
Mailing Address - Country:US
Mailing Address - Phone:805-496-1500
Mailing Address - Fax:
Practice Address - Street 1:3366 E THOUSAND OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-5925
Practice Address - Country:US
Practice Address - Phone:805-496-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 10982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine