Individual
DR. MOE AMADPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1159 ROADRUNNER WAY, SIMI VALLEY, CA 93065-3159
(805) 583-2643
(805) 583-0111
Mailing address
1159 ROADRUNNER WAY, SIMI VALLEY, CA 93065-3159
(805) 583-2643
(805) 583-0111
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G81182
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G811820
—
CA
01
—
95-4761541
INDIVIDUAL TAX ID#
CA
01
—
G81182
MEDICAL STATE LIC#
CA
Enumeration date
09/21/2006
Last updated
05/22/2012
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