Provider Demographics
NPI:1912292947
Name:MOUSSAVI & TOVANYAN MEDICAL GROUP
Entity type:Organization
Organization Name:MOUSSAVI & TOVANYAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-980-1221
Mailing Address - Street 1:11650 RIVERSIDE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1066
Mailing Address - Country:US
Mailing Address - Phone:818-980-1221
Mailing Address - Fax:818-980-3221
Practice Address - Street 1:11650 RIVERSIDE DR STE 5
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1066
Practice Address - Country:US
Practice Address - Phone:818-980-1221
Practice Address - Fax:818-980-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4361Medicare UPIN