Healthcare Provider Details

I. General information

NPI: 1750677324
Provider Name (Legal Business Name): AMINZADEH AND AHMADPOUR MEDICAL CORPORAITON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28038 DOROTHY DR STE 200
AGOURA HILLS CA
91301-4968
US

IV. Provider business mailing address

PO BOX 1890
AGOURA HILLS CA
91376-1890
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-5005
  • Fax: 310-691-5236
Mailing address:
  • Phone: 310-691-5005
  • Fax: 310-691-5236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA115148
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA92270
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA92269
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA92269
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA110113
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA92270
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA92269
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA110113
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA92270
License Number StateCA

VIII. Authorized Official

Name: JAIME FERNANDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-877-0630