Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A106160 | CA |
N | 111NI0900X | Internist | A106160 | CA |
N | 207RC0200X | Critical Care Medicine | A106160 | CA |
Y | 207RP1001X | Pulmonary Disease | A106160 | CA |
NPI | 1003042342 |
---|---|
Provider Name | Mostafa Tabassomi |
First Address | Santa Monica, CA 90403-1313 |
Second Address | Valencia, CA 91355-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 11/11/2019 |