Enliven Aesthetic Medical Clinic

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

A111582 Issued in CA

Legal business name

ENLIVEN AESTHETIC MEDICAL CLINIC

Practice address

23141 Moulton Pkwy Ste 202
Laguna Hills, CA 92653-1241

Phone

(949) 305-2711

Fax

(949) 502-8887

NPI assigned

Jan 24, 2018

Last updated

Jan 24, 2018By 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. Mozhgan Ashtari, MD

Title

Ceo/ MD

Phone

(551) 206-5779

Specialties & licenses 1

Addresses

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

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1518465665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23141 MOULTON PKWY STE 202",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531241",
            "telephone_number": "949-305-2711",
            "fax_number": "949-502-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23141 MOULTON PKWY STE 202",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531241",
            "telephone_number": "949-305-2711",
            "fax_number": "949-502-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIVEN AESTHETIC MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "ASHTARI",
        "authorized_official_first_name": "MOZHGAN",
        "authorized_official_title_or_position": "CEO/ MD",
        "authorized_official_telephone_number": "551-206-5779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A111582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.