Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A128437 | CA |
N | 111NI0900X | Internist | A128437 | CA |
N | 207R00000X | Internist | LP02034 | RI |
N | 111NI0900X | Internist | LP02034 | RI |
NPI | 1003127655 |
---|---|
Provider Name | Moustafa Moataz Aboshady |
First Address | Long Beach, CA 90804 |
Second Address | Los Alamitos, CA 90720-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 17/03/2018 |