Modmd a Professional Corporation

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MODMD A PROFESSIONAL CORPORATION

Practice address

208 Lincoln Blvd
Venice, CA 90291

Phone

(833) 663-6352

Fax

(424) 465-3398

NPI assigned

Jul 19, 2021

Last updated

Feb 4, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sharon Naomi Dabby, MDNPI 1609953124

Title

Ceo/MD

Phone

(833) 663-6352

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sharon Naomi Dabby, MD

  • Emergency Medicine Physician
  • Ontario, CA
  • NPI 1609953124
  NPD Authorized official
• Lisa Farah Dabby, M.D.

  • Emergency Medicine Physician
  • Santa Monica, CA
  • NPI 1891830758
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675468800000",
    "number": "1255904207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "90291",
            "telephone_number": "833-663-6352",
            "fax_number": "424-465-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "90291",
            "telephone_number": "833-663-6352",
            "fax_number": "424-465-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODMD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2023-02-04",
        "certification_date": "2023-02-04",
        "status": "A",
        "authorized_official_last_name": "DABBY",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "NAOMI",
        "authorized_official_title_or_position": "CEO/MD",
        "authorized_official_telephone_number": "833-663-6352",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan J Meza
• Laurie Adriane Millan
• Mindset la Assessments LLC
• Trina L Mitchell
• Victor Luis Mleczko, MD
• Samantha Mohammad, MD
• Christopher Matthew Monpere, PT
• Vivian E Monroy
• Emma Moore, AMFT
• Lakeisha Morgan

• Clinical Medical Laboratory in Venice, CA
• Providers in Venice, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.