1962547042 NPI number — MR. MOHSEN DJILANI P.T.

Table of content: MR. MOHSEN DJILANI P.T. (NPI 1962547042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962547042 NPI number — MR. MOHSEN DJILANI P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DJILANI
Provider First Name:
MOHSEN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962547042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2228 TIMBERLANE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93063-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-306-1371
Provider Business Mailing Address Fax Number:
805-306-1371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
SUITE 3900
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-307-8900
Provider Business Practice Location Address Fax Number:
323-307-8902
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 19065 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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