Provider Demographics
NPI:1962448431
Name:HEIKALI, MOOSSA (MD)
Entity type:Individual
Prefix:MR
First Name:MOOSSA
Middle Name:
Last Name:HEIKALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 49911
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4911
Mailing Address - Country:US
Mailing Address - Phone:818-708-6163
Mailing Address - Fax:818-708-6167
Practice Address - Street 1:18065 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-708-6163
Practice Address - Fax:818-344-1390
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA405592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology