Etie Moghissi, MD,Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A38025 Issued in CA

Legal business name

ETIE MOGHISSI, MD,INC

Practice address

4644 Lincoln Blvd Ste 409
Marina del Rey, CA 90292-6390

Phone

(310) 578-6747

Fax

(310) 578-6750

NPI assigned

Nov 8, 2006

Last updated

Feb 6, 2008By 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

Dr. Etie S Moghissi, MD

Title

President

Phone

(310) 578-6747

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1487723821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD STE 409",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926390",
            "telephone_number": "310-578-6747",
            "fax_number": "310-578-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD STE 409",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926390",
            "telephone_number": "310-578-6747",
            "fax_number": "310-578-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETIE MOGHISSI, MD,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "MOGHISSI",
        "authorized_official_first_name": "ETIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-578-6747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A38025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "A38025",
            "identifier": "LICENSE",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.

Verify at the official NPI Registry.