Provider Demographics
NPI:1508923160
Name:NEMEH, MOUFID (MD)
Entity Type:Individual
Prefix:
First Name:MOUFID
Middle Name:
Last Name:NEMEH
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 1:18250 ROSCOE BLVD
Mailing Address - Street 2:#235
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4226
Mailing Address - Country:US
Mailing Address - Phone:818-885-0063
Mailing Address - Fax:818-885-0193
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:#235
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-885-0063
Practice Address - Fax:818-885-0193
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4323LOtherSTATE LICENSE
CA00A4323LLMedicaid
CABN0346709OtherDEA NUMBER
CABN0346709OtherDEA NUMBER
CAA4323LOtherSTATE LICENSE