Organization
M SHOKRAEI MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD T SHOKRAEI M.D. (PRESIDENT)
(818) 881-0671
Entity
Organization
Contact information
Practice address
6670 RESEDA BLVD, SUITE # 105, RESEDA, CA 91335-5327
(818) 881-0671
(818) 881-7762
Mailing address
PO BOX 491221, LOS ANGELES, CA 90049-9221
(818) 881-0671
(818) 881-7762
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A53012B
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A53012B
MEDICAL LIC. NO.
CA
Enumeration date
03/03/2007
Last updated
06/19/2008
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