Active NPI
Mozhgan Mojab
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1104071380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT19312
- Practice address
- 3670 Barry Ave
Los Angeles, CA 90066-3202 - Phone
- (310) 621-4595
- Fax
- (310) 390-3883
- NPI assigned
- Dec 1, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT19312 | CA | Primary |
Addresses
Primary practice location
3670 Barry Ave
Los Angeles, CA 90066-3202
Mailing address
3670 Barry Ave
Los Angeles, CA 90066-3202
Phone (310) 621-4595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W18826 | Other | CA | MEDICARE PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT19312 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1104071380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3670 BARRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663202",
"telephone_number": "310-621-4595",
"fax_number": "310-390-3883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3670 BARRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663202",
"telephone_number": "310-621-4595",
"fax_number": "310-390-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOJAB",
"first_name": "MOZHGAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-01",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT19312",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER",
"identifier": "W18826",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.