Moadab, Anoosh

Moadab, Anoosh is an sole proprietor health care provider with primary practice located at 6115 N 1St St Ste 101 , Fresno CA 93710-5450. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Moadab, Anoosh can be contacted via phone (559) 436-1213.

Contact Information

Primary practice address
6115 N 1St St Ste 101 Fresno CA 93710-5450
Phone: (559) 436-1213
Fax: (559) 436-4202
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X E4514 California

Profile Details

NPI number 1912904376
LBN Legal business name Moadab, Anoosh
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 30th, 2005
Last updated Apr 20th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912904376 NPPES
California Other 00E45140 BLUE SHIELD
California Other 611685600 BLUE SHIELD
California Other E45140 BLUE SHIELD
California MEDICAID 000E45140 BLUE SHIELD

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