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Etie Moghissi, Md,inc
Clinic/Center in Marina Del Rey, California
NPI 1487723821

Etie Moghissi, Md,inc is a Clinic/Center based in Marina Del Rey, CA. Etie Moghissi, Md,inc practices in Marina Del Rey, CA. The NPI Number for Etie Moghissi, Md,inc is 1487723821 and holds a License No. A38025 (California).

The current practice location address for Etie Moghissi, Md,inc is 4644 Lincoln Blvd Ste 409, Marina Del Rey, CA and can be reached out via phone at 310-578-6747 and via fax at 310-578-6750.

Location: 4644 Lincoln Blvd Ste 409, Marina Del Rey, CA, 90292-6390
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1487723821
Provider Name
Etie Moghissi, Md,inc
Credential
Provider Entity Type
Organization
Address
4644 Lincoln Blvd Ste 409, Marina Del Rey, CA, 90292-6390
Phone Number
310-578-6747
Fax Number
310-578-6750
Provider Enumeration Date
11/08/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
LICENSE 01 CA A38025
institution
Provider Business Practice Location Address Details
Address
4644 Lincoln Blvd Ste 409
City
Marina Del Rey
State
California
Zip
90292-6390
Phone Number
310-578-6747
Fax Number
310-578-6750
person
Provider Business Mailing Address Details
Address
4644 Lincoln Blvd Ste 409
City
Marina Del Rey
State
California
Zip
90292-6390
Phone Number
310-578-6747
Fax Number
310-578-6750
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
A38025 (California)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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