Provider Demographics
NPI:1750622585
Name:JACOB MOUSSAI MD INC
Entity type:Organization
Organization Name:JACOB MOUSSAI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-775-1866
Mailing Address - Street 1:420 S BEVERLY DR STE 100-07
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4426
Mailing Address - Country:US
Mailing Address - Phone:310-775-1866
Mailing Address - Fax:310-444-9306
Practice Address - Street 1:420 S BEVERLY DR STE 100-07
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4426
Practice Address - Country:US
Practice Address - Phone:310-775-1866
Practice Address - Fax:310-444-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty