MEDICARE: DR. JAZBIEH M MOEZZI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35.048376	OH

General Provider Information

NPI Number	:	1043223886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAZBIEH M MOEZZI MD

Provider Business Mailing Address
First Line	:	700 WEST HARBOR DRIVE
Second Line	:	#2702
City	:	SAN DIEGO
State	:	CA
Zip	:	92101
Country	:	US
Telephone Number	:	937-304-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W HARBOR DR
Second Line	:	#2702
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7753
Country	:	US
Telephone Number	:	937-304-4410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/22/2013

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