Healthcare Provider Details

I. General information

NPI: 1396807046
Provider Name (Legal Business Name): BOBBY POURZIAEE, D P M INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 340
BEVERLY HILLS CA
90210-4884
US

IV. Provider business mailing address

6230 WILSHIRE BLVD STE 145
LOS ANGELES CA
90048-5126
US

V. Phone/Fax

Practice location:
  • Phone: 310-441-0088
  • Fax: 310-388-5809
Mailing address:
  • Phone: 310-441-0088
  • Fax: 310-388-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4339
License Number StateCA

VIII. Authorized Official

Name: DR. BOBBY POURZIAEE
Title or Position: PRESIDENT
Credential: DPM
Phone: 310-441-0088