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Individual

PAUL NABEEL MOGANNAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1200 N STATE ST, LOS ANGELES, CA 90033-1029
(323) 226-7242
Mailing address
968 S BARRINGTON AVE APT 1, LOS ANGELES, CA 90049-5574
(650) 218-9350

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A86074
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00679808
RAILROAD MEDICARE
Enumeration date
04/18/2007
Last updated
04/20/2009
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