ETIE MOGHISSI MD NPI 1003007576

Specialist in Marina Del Rey, CA

About ETIE MOGHISSI

Etie Moghissi is a provider in Marina Del Rey, CA with more than 41 years of experience. The NPI number assigned to this provider is 1003007576. The practitioner's primary taxonomy code is Specialist (174400000X). The provider is registered as an individual and their NPI record was last updated 10 years ago. Etie Moghissi is registered with Medicare and accepts claims assignment.

NPI1003007576 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name ETIE MOGHISSI MD
Provider Location Address4644 LINCOLN BLVD SUITE 409 MARINA DEL REY, CA 90292 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address4644 LINCOLN BLVD SUITE 409 MARINA DEL REY, CA 90292 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderFemale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOTHER
Graduation Year1977
Is Sole Proprietor?Yes
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date08-08-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date02-05-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

ETIE MOGHISSI MD
4644 LINCOLN BLVD
SUITE 409
MARINA DEL REY, CA
ZIP 90292
Phone: (301) 578-6747
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Mailing Address

ETIE MOGHISSI MD
4644 LINCOLN BLVD
SUITE 409
MARINA DEL REY, CA
ZIP 90292
Phone: (301) 578-6747

Primary Taxonomy

Taxonomy Code174400000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationSpecialist
TypeOther Service Providers
License No.A38025
License StateCA
Taxonomy DescriptionAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
00A380251MEDICAID (05)CA
A28511MEDICARE UPIN (02)CA
A38025MEDICARE PIN (08)CA

Map Location


ETIE MOGHISSI MD address is 4644 LINCOLN BLVD SUITE 409 MARINA DEL REY, CA 90292

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1073567442DR. MICHAEL GORNIOWSKY M.D.
Individual
Family Medicine4644 LINCOLN BLVD SUITE 428
MARINA DEL REY, CA 90292
(310) 306-1888
1104856293PACIFIC HEARING, INC.
Organization
Specialist4644 LINCOLN BLVD SUITE # 409
MARINA DEL REY, CA 90292
(310) 574-1116
1114911880DR. ANTOINE ROBERTS M.D.
Individual
Orthopaedic Surgery4644 LINCOLN BLVD SUITE 101
MARINA DEL REY, CA 90292
(310) 577-8500
1154315273DR. ELEBY RUDOLPH WASHINGTON III M.D.
Individual
Orthopaedic Surgery4644 LINCOLN BLVD SUITE 101
MARINA DEL REY, CA 90292
(310) 577-8500
1154410710DR. NATALIA MARIA HOMYAK DDS
Individual
Dentist (General Practice)4644 LINCOLN BLVD SUITE 508
MARINA DEL REY, CA 90292
(310) 823-6400
1184771040DANIEL MARCUS,MD,INC
Organization
Specialist4644 LINCOLN BLVD SUITE 414
MARINA DEL REY, CA 90292
(310) 305-1813
1306871348ALAN STEINBERG & STEVEN KREMS ETAL
Organization
Internal Medicine4644 LINCOLN BLVD #111
MARINA DEL REY, CA 90292
(310) 306-6966
1336116854DR. JACQUELINE LEZINE-HANNA MD
Individual
Orthopaedic Surgery (Hand Surgery)4644 LINCOLN BLVD SUITE 101
MARINA DEL REY, CA 90292
(310) 577-8500
1386670602PACIFIC HEARING & BALANCE, INC.
Organization
Specialist4644 LINCOLN BLVD SUITE # 409
MARINA DEL REY, CA 90292
(310) 574-1116
1407871106DR. JONATHAN DAVID RAND MD
Individual
Internal Medicine4644 LINCOLN BLVD #113
MARINA DEL REY, CA 90292
(310) 821-9800
1417061714MR. DANIEL R MARCUS M.D.
Individual
Specialist4644 LINCOLN BLVD SUITE 414
MARINA DEL REY, CA 90292
(310) 305-1813
1508870171 JEREMY E KORMAN M.D.
Individual
Surgery4644 LINCOLN BLVD STE 450
MARINA DEL REY, CA 90292
(800) 491-1977
1578586590DR. ROBERT LEO BERKOWITZ MD
Individual
Internal Medicine4644 LINCOLN BLVD 111
MARINA DEL REY, CA 90292
(310) 306-6966
1689752164 AKASH BAJAJ MD
Individual
Pain Medicine (Interventional Pain Medicine)4644 LINCOLN BLVD SUITE 424
MARINA DEL REY, CA 90292
(310) 482-6906
1720184666PAUL B DONZIS MD INC
Organization
Ophthalmology4644 LINCOLN BLVD #102
MARINA DEL REY, CA 90292
(310) 822-0022
1831291632DR. IRVING SOBEL MD
Individual
Internal Medicine4644 LINCOLN BLVD 114
MARINA DEL REY, CA 90292
(310) 821-9800
1871519959MS. HELEEN ROBINS M.D.
Individual
Family Medicine4644 LINCOLN BLVD #408
MARINA DEL REY, CA 90292
(310) 821-0320
1912923459DR. MICHAEL WAYLAND RUBOTTOM MD
Individual
Internal Medicine4644 LINCOLN BLVD SUITE 400
MARINA DEL REY, CA 90292
(310) 821-2060
1962428045DR. ANDREA DENISE RUMAN MD
Individual
Internal Medicine4644 LINCOLN BLVD #111
MARINA DEL REY, CA 90292
(310) 306-6966
1972605020DR. STEVEN MICHAEL KREMS MD
Individual
Internal Medicine4644 LINCOLN BLVD #11
MARINA DEL REY, CA 90292
(310) 306-6966