Organization
ETIE MOGHISSI, MD,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETIE S MOGHISSI MD (PRESIDENT)
(310) 578-6747
Entity
Organization
Contact information
Practice address
4644 LINCOLN BLVD STE 409, MARINA DEL REY, CA 90292-6390
(310) 578-6747
(310) 578-6750
Mailing address
4644 LINCOLN BLVD STE 409, MARINA DEL REY, CA 90292-6390
(310) 578-6747
(310) 578-6750
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A38025
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE
A38025
CA
Enumeration date
11/08/2006
Last updated
02/06/2008
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