Organization
MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC
Active
Other names
PHYSICAL THERAPY ON LINE
Organization subpart
No
Provider details
NPI number
Authorized official
MOZHGAN MOJAB (CEO)
(310) 621-4595
Entity
Organization
Contact information
Practice address
3670 BARRY AVE, LOS ANGELES, CA 90066-3202
(310) 621-4595
(310) 390-3883
Mailing address
3670 BARRY AVE, LOS ANGELES, CA 90066-3202
(310) 621-4595
(310) 390-3883
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
PT 19312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18826
MEDICARE PROVIDER NUMBER
CA
Enumeration date
12/01/2008
Last updated
08/11/2009
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