Provider Demographics
NPI:1912403486
Name:MAHOOZI, ELHAM
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:MAHOOZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 S BEVERLY GLEN BLVD APT 508
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5241
Mailing Address - Country:US
Mailing Address - Phone:310-739-0539
Mailing Address - Fax:
Practice Address - Street 1:1377 S BEVERLY GLEN BLVD APT 508
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5241
Practice Address - Country:US
Practice Address - Phone:310-739-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17298171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist