Healthcare Provider Details

I. General information

NPI: 1205369162
Provider Name (Legal Business Name): PARNIAN CHANGIZZADEH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MESQUITE AVE STE 202
LAKE HAVASU CITY AZ
86403-5681
US

IV. Provider business mailing address

1851 MESQUITE AVE STE 202
LAKE HAVASU CITY AZ
86403-5681
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-0094
  • Fax: 928-680-8986
Mailing address:
  • Phone: 928-854-0094
  • Fax: 928-680-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61157
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: