1467644310 NPI number — JASMINE MOGHISSI, M.D., P.C.

Table of content: (NPI 1467644310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467644310 NPI number — JASMINE MOGHISSI, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASMINE MOGHISSI, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467644310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9401 LEE HWY
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-281-5560
Provider Business Mailing Address Fax Number:
703-281-5568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9401 LEE HWY
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-281-5560
Provider Business Practice Location Address Fax Number:
703-281-5568
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOGHISSI
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-281-5560

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101044043 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DF2854 / P00353016 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com