Active NPI
Linda Moghtader, M.D.
- Psychosomatic Medicine Physician
- Los Angeles, CA
National Provider Identifier
1497963722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychosomatic Medicine Physician
- License
- G56261
- Practice address
- 12300 Wilshire Blvd
Suite 330
Los Angeles, CA 90025-1020 - Phone
- (310) 442-7601
- NPI assigned
- May 18, 2007
- 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 |
|---|---|---|---|---|
| Psychosomatic Medicine Physician | 2084P0015X | G56261 | CA | Primary |
Addresses
Primary practice location
12300 Wilshire Blvd
Suite 330
Los Angeles, CA 90025-1020
Mailing address
12300 Wilshire Blvd
Suite 330
Los Angeles, CA 90025-1020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56261 | CA | MD | Mental Health Counselor |
| G56261 | CA | MD | Psychosomatic Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497963722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12300 WILSHIRE BLVD",
"address_2": "SUITE 330",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12300 WILSHIRE BLVD",
"address_2": "SUITE 330",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251020",
"telephone_number": "310-442-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHTADER",
"first_name": "LINDA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0015X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychosomatic Medicine",
"state": "CA",
"license": "G56261",
"primary": true
}
],
"identifiers": [],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.