Individual ProviderMohammad GhalichiInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address8631 W 3rd St Ste 815e, Los Angeles, CA 90048-5901(424) 340-5222(832) 221-0989PECOS EnrollmentBased on the most recent information from CMS, provider Mohammad Ghalichi is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1265697957Provider TypeIndividualFull NameGhalichi, MohammadCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date7/23/2008Last Updated8/10/2021Contact InformationPractice LocationPractice Address8631 W 3rd St Ste 815e, Los Angeles, CA 90048-5901Phone(424) 340-5222Fax(424) 206-4938Mailing LocationMailing Address8631 W 3rd St Ste 815e, Los Angeles, CA 90048-5901Phone(832) 221-0989FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207RC0000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseA103682CaliforniaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseP1311TexasCode207RC0000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseP1311TexasProvider IdentifiersIDDescriptionIssuerID323128402DescriptionMedicaidIssuerUnlistedTexasID323128403DescriptionMedicaidIssuerUnlistedTexasID323128404DescriptionMedicaidIssuerUnlistedTexas