Provider Demographics
NPI:1962526756
Name:MOSTAFAVI, ADEL (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:
Last Name:MOSTAFAVI
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 1:13701 RIVERSIDE DR
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2430
Mailing Address - Country:US
Mailing Address - Phone:310-871-0670
Mailing Address - Fax:310-469-7845
Practice Address - Street 1:801 S GRAND AVE STE 475
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4622
Practice Address - Country:US
Practice Address - Phone:310-871-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA924722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry