Provider Demographics
NPI:1447008750
Name:MOABED, POUYAN (OWNER)
Entity type:Individual
Prefix:
First Name:POUYAN
Middle Name:
Last Name:MOABED
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 N 24TH ST STE 114-595
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7844
Mailing Address - Country:US
Mailing Address - Phone:602-662-1333
Mailing Address - Fax:602-281-4960
Practice Address - Street 1:2942 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7844
Practice Address - Country:US
Practice Address - Phone:602-662-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide