Provider Demographics
NPI:1356967699
Name:MOHSEN TAVOUSSI, D.O. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MOHSEN TAVOUSSI, D.O. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-608-4106
Mailing Address - Street 1:210 MONARCH BAY DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3438
Mailing Address - Country:US
Mailing Address - Phone:714-608-4106
Mailing Address - Fax:
Practice Address - Street 1:9209 COLIMA RD STE 2300
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1817
Practice Address - Country:US
Practice Address - Phone:866-503-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty